JAWS Nitinol Staple System Survey

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* 1. What was the case date?

Case Date

Date

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* 2. Reps name who covered case?

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* 3. Name of Surgeon (First and Last)

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* 4. Surgeon License Number (if available)

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* 5. Facility where surgery was performed

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* 6. What type and size implant was used?

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* 7. Please answer the following questions regarding the JAWS Implants:

	Strongly Disagree	Disagree	Impartial	Agree	Strongly Agree
The implants met their intended use	The implants met their intended use Strongly Disagree	The implants met their intended use Disagree	The implants met their intended use Impartial	The implants met their intended use Agree	The implants met their intended use Strongly Agree
The implants are easily identifiable	The implants are easily identifiable Strongly Disagree	The implants are easily identifiable Disagree	The implants are easily identifiable Impartial	The implants are easily identifiable Agree	The implants are easily identifiable Strongly Agree
The implants adequately interfaced with instruments	The implants adequately interfaced with instruments Strongly Disagree	The implants adequately interfaced with instruments Disagree	The implants adequately interfaced with instruments Impartial	The implants adequately interfaced with instruments Agree	The implants adequately interfaced with instruments Strongly Agree

If disagree or strongly disagree please explain:

Question Title

* 8. Instruments: the following met expectations:

	Strongly Disagree	Disagree	Impartial	Agree	Strongly Agree	N/A
1.6 mm x 100 mm K-Wire	1.6 mm x 100 mm K-Wire Strongly Disagree	1.6 mm x 100 mm K-Wire Disagree	1.6 mm x 100 mm K-Wire Impartial	1.6 mm x 100 mm K-Wire Agree	1.6 mm x 100 mm K-Wire Strongly Agree	1.6 mm x 100 mm K-Wire N/A
Small Locating Pin (8 and 10mm kits)	Small Locating Pin (8 and 10mm kits) Strongly Disagree	Small Locating Pin (8 and 10mm kits) Disagree	Small Locating Pin (8 and 10mm kits) Impartial	Small Locating Pin (8 and 10mm kits) Agree	Small Locating Pin (8 and 10mm kits) Strongly Agree	Small Locating Pin (8 and 10mm kits) N/A
Large Locating Pin (20 mm kits)	Large Locating Pin (20 mm kits) Strongly Disagree	Large Locating Pin (20 mm kits) Disagree	Large Locating Pin (20 mm kits) Impartial	Large Locating Pin (20 mm kits) Agree	Large Locating Pin (20 mm kits) Strongly Agree	Large Locating Pin (20 mm kits) N/A
Drill Guide	Drill Guide Strongly Disagree	Drill Guide Disagree	Drill Guide Impartial	Drill Guide Agree	Drill Guide Strongly Agree	Drill Guide N/A
Staple Inserter	Staple Inserter Strongly Disagree	Staple Inserter Disagree	Staple Inserter Impartial	Staple Inserter Agree	Staple Inserter Strongly Agree	Staple Inserter N/A
Drill	Drill Strongly Disagree	Drill Disagree	Drill Impartial	Drill Agree	Drill Strongly Agree	Drill N/A

If disagree or strongly disagree please explain:

Question Title

* 9. Overall System Raiting

Poor

Excellent

Poor

Excellent

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* 10. Please list procedure(s) where the JAWS Nitinol Staple was used for fixation:

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* 11. Are there any interoperative or post-operative flouro images you can provide to Paragon 28?

Yes, and you may use them for marketing purposes

Yes, but not for use on marketing material

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* 12. If any, what foot and ankle products were used in conjunction with the JAWS Staple?
(Paragon 28 products or another company.)

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* 13. What is the chance of the surgeon using the system again?

Highly Unlikely

Unlikely

Unsure

Likely

Highly Likely

Highly Unlikely

Unlikely

Unsure

Likely

Highly Likely

JAWS Nitinol Staple System Survey - V.2

Market Release Feedback

Question Title

* 1. What was the case date?

Question Title

* 2. Reps name who covered case?

Question Title

* 3. Name of Surgeon (First and Last)

Question Title

* 4. Surgeon License Number (if available)

Question Title

* 5. Facility where surgery was performed

Question Title

* 6. What type and size implant was used?

Question Title

* 7. Please answer the following questions regarding the JAWS Implants:

Question Title

* 8. Instruments: the following met expectations:

Question Title

* 9. Overall System Raiting

Question Title

* 10. Please list procedure(s) where the JAWS Nitinol Staple was used for fixation:

Question Title

* 11. Are there any interoperative or post-operative flouro images you can provide to Paragon 28?

Question Title

* 12. If any, what foot and ankle products were used in conjunction with the JAWS Staple?
(Paragon 28 products or another company.)

Question Title

* 13. What is the chance of the surgeon using the system again?

Question Title

* 14. Additional Comments:

Question Title

* 1. What was the case date?

Question Title

* 2. Reps name who covered case?

Question Title

* 3. Name of Surgeon (First and Last)

Question Title

* 4. Surgeon License Number (if available)

Question Title

* 5. Facility where surgery was performed

Question Title

* 6. What type and size implant was used?

Question Title

* 7. Please answer the following questions regarding the JAWS Implants:

Question Title

* 8. Instruments: the following met expectations:

Question Title

* 9. Overall System Raiting

Question Title

* 10. Please list procedure(s) where the JAWS Nitinol Staple was used for fixation:

Question Title

* 11. Are there any interoperative or post-operative flouro images you can provide to Paragon 28?

Question Title

* 12. If any, what foot and ankle products were used in conjunction with the JAWS Staple?(Paragon 28 products or another company.)

Question Title

* 13. What is the chance of the surgeon using the system again?

Question Title

* 14. Additional Comments:

* 12. If any, what foot and ankle products were used in conjunction with the JAWS Staple?
(Paragon 28 products or another company.)