First Name

Last Name

Email Address

Phone Number

Apt, Suite, Bldg (Optional)

Street

City

State

Were technicians on time for scheduled appointments? Were technicians on time for scheduled appointments? 1 2 3 4 5

Did technicians leave your home clean (5 being cleanest)? Did technicians leave your home clean (5 being cleanest)? 1 2 3 4 5

Were technicians knowledgeable and professional in their field? Were technicians knowledgeable and professional in their field? 1 2 3 4 5

Was the quality of the work completed to your satisfaction and in a timely manner? Was the quality of the work completed to your satisfaction and in a timely manner? 1 2 3 4 5

Did MaxCARE communicate with you effectively throughout the process? Did MaxCARE communicate with you effectively throughout the process? 1 2 3 4 5

Would you use MaxCARE again? Would you use MaxCARE again? Yes No

Would you refer MaxCARE to a friend? Would you refer MaxCARE to a friend? Yes No

May we use this survey in future literature and/or advertisements? May we use this survey in future literature and/or advertisements? Yes No

May we use your name and a phone number on a referral list for potential clients? May we use your name and a phone number on a referral list for potential clients? Yes No