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Product Feedback

Please help us by taking a few minutes to fill out the following Product Feedback Form for product supplied to your facility.

Please Indicate Product Used:

Product:
Catalog No.:*

Procedure

Please indicate the procedure for which the device was used

Procedure:
Did the device perform adequately according to the intended purpose?
Comments:
Were the Instructions for Use clear and Complete for using the product?
Comments:

Design

Are there any device improvements that can be done to improve the device or reduce any risks?
 
Suggestions:

Information

First Name:*
Last Name:*
Title:
Facility:*
Phone:*
Dept:
Date: