We work hard to assure accurate information & welcome the opportunity to improve customer satisfaction...

The HPTC Team takes pride in delivering  quality information in a timely manner and we value your opinion. Please let us know how we can deepen relationships and build on our success to better serve you by completing the brief survey below.

1. Which of the following product(s) have you used?

Directory

Electronic File

Map

 Mailing Labels

Roster

 Statistical Summary

 Other 

2. The product(s) met my expectations.

Strongly Agree

Agree

Undecided

Disagree

Strongly Disagree

3. The timeliness of the product(s) delivery met my expectations.

Strongly Agree

Agree

Undecided

Disagree

Strongly Disagree

4. The quality of the HPTC customer service met my expectations.

Strongly Agree

Agree

Undecided

Disagree

Strongly Disagree

5. The HPTC collects and maintains information on the following.  Please check all that are of interest to you.

 Physicians

 Physician Assistants

 Nurse Practitioners

 Dentists

 Pharmacists

 Hospital Administrators/CEO's

 Laboratory Directors

 Microbiology Coordinators

 Infection Control Nurses

 Emergency Nurses

 Public Health Officials

 Water Operators

 Veterinarians

 Behavioral Health Professionals

 First Responders

 Respiratory Care Practitioners

 Hospitals

 Clinics/Practice Locations 

 Pharmacies

 Dental Offices

 Long Term Care & Assisted Living Facilities

 Medical Suppliers and Services

 Emergency Medical Services

 Fire Services

 Other:

6. The HPTC maintains information in Nebraska and Western Iowa.  Please check the geographic areas of interest to you.

 Nebraska

 Western Iowa

 Nebraska and Western Iowa

 Additional States or Geographic Areas:

7. I plan to request services from the HPTC in the near future.

Strongly Agree

Agree

Undecided

Disagree

Strongly Disagree

8. Would your organization be interested in advertising in the HPTC Directory of Nebraska & Western Iowa Healthcare Resources? 

 Yes     

 No

 Undecided. Please contact me to provide additional information.  

9. Please provide additional comments regarding the HPTC products or customer service you received.

10. Please define additional products or services of interest to you.

Contact Information (Optional)

Business Name

Contact Name

Mailing Address 1

Mailing Address 2

City

State

AL AK AZ AK CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY     

Zip Code

 - 

Telephone

Email Address

Thank you for taking time out of your busy schedule to help us improve to meet your business needs.

Sincerely,

HPTC Team

	Type the text on the left into the space below.
	Visual Help...       Why...