Referral Source Survey

Dear Customer:

As the manager of Orthofix I want to thank you for giving us the opportunity to serve you. Please help us serve you better by taking a couple of minutes to tell us about the service that you have received so far. We appreciate your business and want to make sure we meet your expectations.

Sincerely,

[MANAGER_NAME]

Manager

Based upon your most recent experience with Orthofix, how would you rate the quality of service you received:

If you indicated that the service was unsatisfactory, would you please describe what happened?

The process for getting your concerns resolved was:

Would you please take a few minutes to describe what happened?

Now please think about the features and benefits of the bone growth stimulator itself. How satisfied are you with the product:

Would you please take a few minutes to describe why you are not satisfied with the product?

Company Representative

The following questions pertain to the company representative you communicated with most recently. Please indicate whether you agree or disagree with the following statements

Are there any other comments about the customer service representative you would like to add?

	Very Satisfied	Somewhat Satisfied	Neutral	Somewhat Dissatisfied	Very Dissatisfied
Considering the total package offered by including customer service, bone growth stimulator features and benefits, and cost; how satisfied are you with Orthofix?

Thank you for your feedback. We sincerely appreciate your honest opinion and will take your input into consideration while providing products and services in the future.

If you have any comments or concerns about this survey please Contact: -

[COMPANY]

[MANAGER_NAME]

[ADDRESS_1]

[ADDRESS_2]

[CITY], [STATE], [ZIP]