Feedback Form | Total Scope, Inc.

Name*
First Last
Phone*
Phone Extension
Hospital*
Department*
Email*
Medical Device Model
Work Order #*
Our ability to repair your medical device?*
The reliability or accuracy of our estimate?*
The professionalism and courtesy of our staff?*
Our turnaround time?*
How quickly and smoothly the process went for getting your equipment sent to us?*
Likelihood that you will use Total Scope again?*
Would you refer Total Scope to another department or facility?*
- Yes
- No
- Yes, but I don't have a referral at this time
Receive 25% OFF your next repair if you provide us with the name of the referral, Facility Name and Phone Number and receive 50% OFF if you also provide us with the Department name and Contact Email. *The contact you refer must use our services to receive your discount.
Name of Person You Are Referring Us To*
First Last
Facility Name*
Contact Phone*
Department Name
Contact Email
Would you like to be contacted about this repair?*
Is there anything we can do to improve your medical device repair experience?*
Would you like to serve as a reference for customers interested in using Total Scope?*
- Yes
- No
Would you be willing to leave a testimonial? If so, please tell us what you liked about our services.*
Receive Emails*
Email
This field is for validation purposes and should be left unchanged.