Feedback Form | Total Scope, Inc.

"*" indicates required fields

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

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

Would you be willing to leave a testimonial? If so, please tell us what you liked about our services.*

Receive Emails*