Envision™ End User
*
1.
Country
(Required.)
2.
Facility
*
3.
Product Used
(Required.)
Envision™ cover
Envision™ pad
4.
Item Number(s) Used
*
5.
Procedure(s) Performed
(Required.)
Surgical wound ultrasound scanning
Fine needle aspiration (FNA)
Vascular access
Regional anesthesia
Core biopsy
Intraoperative ultrasound scanning
Other (please specify)
*
6.
Anatomy Targeted
(Required.)
Abdomen
Head/Neck
Thyroid
Pelvis
Breast
Extremities
Other (please specify)
7.
Rate satisfaction on a scale of 1 to 5 (1 being the lowest level of satisfaction & 5 being the highest level of satisfaction)
1-Low Satisfaction
2
3
4
5-High Satisfaction
Based on product design, rate the ease of use of the product in the clinical setting.
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
How satisfied are you with the quality of this product?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
How well did the product serve as a microbial barrier between probe and patient?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
How well did the product serve as an imaging medium, eliminating the need for ultrasound gel?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
8.
Based on your clinical expertise, do you believe there is added patient risk associated with the use of this product?
No
Yes (if yes, please explain in Comment box below)
Comment
9.
Please provide your email address in order for CIVCO to respond to any concerns.
