How satisfied were you with the STAXI chair on each item?
Overall quality
Very Dissatisfied
1.
2.
3.
4.
5. Very Satisfied
Not Applicable
Ease of Motion
Very Dissatisfied
1.
2.
3.
4.
5. Very Satisfied
Not Applicable
Durability
Very Dissatisfied
1.
2.
3.
4.
5. Very Satisfied
Not Applicable
Arm & Leg Rests
Very Dissatisfied
1.
2.
3.
4.
5. Very Satisfied
Not Applicable
Overall experience
Very Dissatisfied
1.
2.
3.
4.
5. Very Satisfied
Not Applicable
How long did you use the STAXI chair?
6 hours or more
4 to 6 hours
2 to 4 hours
1 to 2 hours
30 mins to one hour
30 mins or less
What was your purpose for using the STAXI chair?
Patient Discharge
Assist family member or friend to Clinic Appointment
To help with extra bags or flowers
To transport small child around hospital
Other
How often would you use the STAXI chair?
Once a week or more often
Only if a wheelchair is not available
Once a month
Every 2-3 months
2-3 times a year
Once a year or less often
Would not use
Compared to other wheelchairs that are available, would you say that the STAXI is:
Much better
Somewhat better
About the same
Somewhat worse
Much worse
Don't know or never used
How likely are you to recommend the STAXI chair to others?
Definitely will recommend
Probably will recommend
Not sure
Probably will not recommend
Definitely will not recommend
Never Used
What would you like to tell us about your satisfaction with the STAXI chair that was not already asked in this survey?
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