Envision™ End User Survey

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* 3. Product Used

Envision™ cover

Envision™ pad

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* 4. Item Number(s) Used

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* 5. Procedure(s) Performed

Surgical wound ultrasound scanning

Fine needle aspiration (FNA)

Vascular access

Regional anesthesia

Core biopsy

Intraoperative ultrasound scanning

Other (please specify)

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* 6. Anatomy Targeted

Abdomen

Head/Neck

Thyroid

Pelvis

Breast

Extremities

Other (please specify)

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* 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.	Based on product design, rate the ease of use of the product in the clinical setting. 1-Low Satisfaction	Based on product design, rate the ease of use of the product in the clinical setting. 2	Based on product design, rate the ease of use of the product in the clinical setting. 3	Based on product design, rate the ease of use of the product in the clinical setting. 4	Based on product design, rate the ease of use of the product in the clinical setting. 5-High Satisfaction
Comment
How satisfied are you with the quality of this product?	How satisfied are you with the quality of this product? 1-Low Satisfaction	How satisfied are you with the quality of this product? 2	How satisfied are you with the quality of this product? 3	How satisfied are you with the quality of this product? 4	How satisfied are you with the quality of this product? 5-High Satisfaction
Comment
How well did the product serve as a microbial barrier between probe and patient?	How well did the product serve as a microbial barrier between probe and patient? 1-Low Satisfaction	How well did the product serve as a microbial barrier between probe and patient? 2	How well did the product serve as a microbial barrier between probe and patient? 3	How well did the product serve as a microbial barrier between probe and patient? 4	How well did the product serve as a microbial barrier between probe and patient? 5-High Satisfaction
Comment
How well did the product serve as an imaging medium, eliminating the need for ultrasound gel?	How well did the product serve as an imaging medium, eliminating the need for ultrasound gel? 1-Low Satisfaction	How well did the product serve as an imaging medium, eliminating the need for ultrasound gel? 2	How well did the product serve as an imaging medium, eliminating the need for ultrasound gel? 3	How well did the product serve as an imaging medium, eliminating the need for ultrasound gel? 4	How well did the product serve as an imaging medium, eliminating the need for ultrasound gel? 5-High Satisfaction
Comment

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* 8. Based on your clinical expertise, do you believe there is added patient risk associated with the use of this product?

Yes (if yes, please explain in Comment box below)

Comment

Envision™ End User

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* 1. Country

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* 2. Facility

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* 3. Product Used

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* 4. Item Number(s) Used

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* 5. Procedure(s) Performed

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* 6. Anatomy Targeted

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* 7. Rate satisfaction on a scale of 1 to 5 (1 being the lowest level of satisfaction & 5 being the highest level of satisfaction)

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* 8. Based on your clinical expertise, do you believe there is added patient risk associated with the use of this product?

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* 9. Please provide your email address in order for CIVCO to respond to any concerns.