Reliance Dental is committed to continuously improving the
quality of its products and services.  Please help us to better
help you by responding to this brief survey.
---------------------------------------------------------------------------------------
Name:
Company:
Phone:
Email:
-------------------------------------------------------------------------------------
When you receive your orders, they are usually
received __________ the expected delivery date.
Before    
On
After
How would you describe the condition of the order at the
time of receipt:
Good
Excellent
 Fair
 Poor
How would you describe the accuracy of the items
received:
Good
Excellent
 Fair
 Poor
When contacting Reliance Dental by phone, how would
rate your satisfaction and Reliance Dental's helpfulness:
Good
Excellent
 Fair
 Poor
-------------------------------------------------------------------------------------
Have you received any feedback from your customers
regarding Reliance Dental's products?
Yes
No
If yes, please explain:
Please provide us with any suggestions or comments
that would help to improve our products or services:
__________________________________________________________
Reliance Dental Mfg. Co. ~ 5805 W. 117th Place ~ PO Box 38 ~ Worth, IL 60482
Phone: (708) 597-6694  Fax: (708) 597-7560   Email:reliancedental@sbcglobal.net


Customer Satisfaction Survey
Reliance Dental Manufacturing
-Quality Dental Supplies Since 1894-