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Satisfaction Survey

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Satisfaction Survey

Your feedback matters. Tell us how we are doing.

Satisfaction Survey

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Date*
MM slash DD slash YYYY
Name
First Last
Phone*
Email*
Items were delivered in a timely manner.*
- Yes
- No
- N/A
Items were ready for patient use upon delivery.*
- Yes
- No
- N/A
Received and understood instructions on proper use of items.*
- Yes
- No
- N/A
Feel confident to use items.*
- Yes
- No
- N/A
Received info on my Rights & Responsibilities (Consent and Authorization Form).*
- Yes
- No
- N/A
Response to my questions, problems, concerns were addressed in a timely manner.*
- Yes
- No
- N/A
Satisfied with the items.*
- Yes
- No
- N/A
Satisfied with the service. Would recommend to others.*
- Yes
- No
- N/A
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© Copyright 2025 Milk Moms.
All rights reserved.

13783 Ibis St NW Ste 200
Andover, MN 55304

Phone: 763-259-8824
Fax: 763-413-9741

Office Hours: 10:00-4:00, M-F
Phone Hours: 8:30-4:30, M-F

OUR MISSION

Our goal is to help each Mom achieve success with her breastfeeding journey by providing the best nursing tools and highest quality of service

© Copyright Milk Moms. All rights reserved.