Customer Feedback Form

Please complete the following questions to receive your complimentary Sheaffer writing pen.
Name:  *
Position:  *
Health facility:  *
Email Address:  *
Street Name:  *
City:  *
State:  *
Postcode:  *
Phone Number: 
Have you had any previous dealings with Hipac?:  *
If this is your first experience, how did you come to know about us?: 
From time to time we offer special promotions and new product updates. What is your preferred method of delivery?:  *
How do you rate the quality of our products?:  *
How do you rate your experience dealing with our Customer Care Team?:  *
How do you rate our delivery times?:  *
We foster long lasting relationships. We invite you to share with us any suggestions you may have on how we can make your future dealings with Hipac even better: 
Thank you for taking the time to complete this survey. We value your feedback and look forward to working with you into the future.