Product Feedback - A Clinical Survey

You, the customer, are the lifeblood of our company. The feedback you provide is critical to the success or our products. Your design preferences and suggestions are evaluated and often incorporated into our products.
Please take a moment from time to time to complete this survey. Thank you for taking the time during your busy schedule!

Clinical Survey Form:			* required
	Product Name *
	Size
		Meets Need	Improve †
	Lumen
	Cuff
	Suture Wing
	Splitting
	Luer
	Clamp
	Performance (flow)
	Site Care - Compatibility
	Instructions
	Stat Lock®
	Guidewire
	Introducer (cannula)
	Tunneler (trocar)
	Packaging
	† Checking "Improve" for any item makes the "Comments" box a required field. Comments:
	May we contact you if we have any questions? Yes No Thanks
	Name:
	Title/Position:
	Company Clinic / Facility Other Organization
	Company Name:
	Street Address:
	City:
	State/Province:
	Zip/Postal Code:
	Country:
	Telephone:
	Fax:
	Email:
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	Thank You for your valuable feedback!
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