Ortho Solutions Post-Market Customer Feedback Form

CUSTOMER FEEDBACK FORM
General Feedback
As a valued customer we would appreciate a small amount of your time to complete this Customer Feedback Form.

The purpose of this form is to gather feedback on the use of Ortho Solutions products and the associated Instructions for Use. Your responses will be reviewed to support ongoing assessment of product quality, usability, customer service, and to help drive continual improvement.
Hospital Name:*
Sales Rep:*
Name:*
Email:
Department:
Role
Date:*

DayMonthYear
Date

Please provide a rating for your experience by ticking in the corresponding boxes.*

	Excellent	Good	Fair	Requires Improvement*
Customer Service Experience
Customer Support
Delivery/Loan Service
Feedback/Complaint Handling
Device Performance
Device Usability
Information Supplied by Manufacturer
Product Range
Competitiveness
Product Pricing
Meeting Requirements Overall

Device/System(s) Used:*
What makes you choose Ortho Solutions Products?
Do you believe that Ortho Solutions can improve in any of the following areas?

N/APricingProductsPackaging/LabellingServiceStock
If so, please use the space below to provide any additional comments or suggestions.
eIFU Feedback
We welcome your feedback on the electronic Instructions for Use (eIFUs) provides for Ortho Solutions devices. Your input helps us ensure that IFUs are accurate, accessible, and easy to use.

Feedback is reviewd on a routine basis to support continual improvement of information provided with our devices and to ensure users have access to clear and appropriate instructions.

Please rate your experience by selecting the option that best reflects your experience in each area below:

	Excellent	Good	Fair	Requires Improvement
eIFU Accessibility
Professional Use and Relevance
Paper IFU Provision (if requested)
Translation and Localisation
Device Labelling
Contact

Applicable eIFU
Do you believe that Ortho Solutions can improve in any of the following areas?

N/AAccessibilityContentPaper IFU ProvisionTranslationLabellingContact
If so, please use the space below to provide any additional comments or suggestions.
Signature:*
Should be Empty:

CUSTOMER FEEDBACK FORM