Rate our home visit

We’d like to know how you’d rate the visits or service calls we make to your home. We count on our clients to help us improve our services and find the best ways to meet your needs.

If you’ve recently had a home visit from a Respiratory Therapist or a Biomed Technician, please take a minute to fill in the form on this page.

Thank you very much for your input.

RATING FORM

First (required)

Last Name (optional)

BCITS Staff Person

Reason for the visit

Date of visit

Please tell us how you rate the service or assistance you received.

Other comments about your visit

Your Email (if you would like a response)


You are donating to : BCITS

How much would you like to donate?
$10 $20 $30
Would you like to make regular donations? I would like to make donation(s)
How many times would you like this to recur? (including this payment) *
Name *
Last Name *
Email *
Phone
Address
Additional Note
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