CUSTOMER CONTACT FORM

If you would like any further details about Gerald Simonds, our range of products and services, or if you would like us to contact you directly, please complete the following:

Title:

Daytime Telephone:

First Name

Evening Telephone:

Surname:

Email:

Address

Date of Birth:

Disability:

Town:

Please tick if you are happy for us to contact you occasionally by email

County:

All details supplied to us will be treated confidentially and will not be disclosed to any third party

Postcode:

Customer Satisfaction Survey

If you have ever bought anything from Gerald Simonds, it would help us to know about your experiences of dealing with us. We will consider all your responses and comments seriously and, where necessary, take appropriate action. Please answer the questions below by ticking the appropriate box. We would also be interested to know if there are any other products or services you would like to see in our range.

What did you buy from us?

Please use this space to give further details of the answers given above, or to add any other comments:

Thank you for taking the time to complete this questionnaire.

Gerald Simonds Healthcare Ltd. | 9 March Place, Gatehouse Way, Aylesbury, Bucks, HP19 8UA
T: 01296 380 200 | F: 01296 380 279 | E: webenquiry@gerald-simonds.co.uk