Take Our Survey

Take a moment to fill out our survey. Your insights are very helpful to us as we strive to improve our products and customer service. As a show of gratitute for your participation, we'd like to offer you 10% off your next order. You'll receive an email with a coupon code for you to use the next time you order.

First Name *

Last Name *

Facility *

Address of Facility *

City *

State *

Zip Code *

Phone Number *

Email Address *

Who makes purchasing decisions for your facility? *

Rank the following factors, in order of importance, when making purchasing decisions for Advance Directive materials. 🛈

	Price
	Accuracy of content
	Ease of ordering
	Compliance with federal law
	Branding and marketing of your facility
	Ease of use for patients

Is there anything we can do to improve your experience dealing with Professional Media Resources?

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Are there any changes we can make to our Advance Directives that would better serve your facility?

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Give us a brief description of other products or services we can offer your facility.

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