The following is a brief survey regarding your experience and perception of Rollx Vans products. The purpose of the survey is for feedback to find areas we may improve. We appreciate your time. Please rate the following on a 1-5 scale with 1 being low and 5 as highest.

1.

Quality of products (workmanship, finished product as delivered to patient) *

2.

Industry safety standards (FMVSS, crash testing, NHTSA standards) *

3.

Patient/Wheelchair (other mobility device) compatibility *

4.

Correct modification and equipment as prescription upon delivery/inspection. *

5.

Service (Expediency for repairs or adjustments) *

6.

Rate your experience and convenience working with Rollx (If Limited Experience with Rollx please note below in comments) *

7.

Optional: We wish for this survey to be anonymous, however there may be geographical areas where we may improve. What area do you service?:

8.

Comments or suggestions; please provide recommendations as to how we may improve.