PCI medical is continually working on improvement in all areas. Please complete this survey and our President, Philip Coles, will give it his immediate attention. Thank you for taking the time to complete our survey form.

Items in red are required.

Company
Customer Contact
Name
Email
Please rate the following 5 items: 5 = Excellent 1 = Poor
Delivery Performance	5 4 3 2 1
Quality	5 4 3 2 1
Order Completeness	5 4 3 2 1
Responsiveness to Issues	5 4 3 2 1
Courtesy	5 4 3 2 1
Please indicate how we rate compared with your other suppliers. Specific Issues or Comments?