What template would i use for feedback after equipment installati

[jmskinfresh]

my employer wants me to make up a questioneer for the offices i have been to
and have installed medical equipment in. they would like me to send this form
via email for the ontact person that is doing the treatment can fill out and
send back to me with there input on the device as well as what results they
are achiving as well as the problem areas, how we can adress them ,
etc....basically a follow up form to see what more we can do to ake sure they
are happy with the product and if not happy why?

thanks for your time and help,
john m.

 

[Mary Sauer]

See if you can adapt one of these
http://office.microsoft.com/en-us/results.aspx?Scope=TC&Query=feedback