To be completed by CurvaFix employees for every case

Question Title

* 1. Representative Name

Question Title

* 2. Customer Status:

Question Title

* 3. Surgeon Name

Question Title

* 4. Fill in the surgery date:

Date
LP Case Questions:

Question Title

* 5. Did the implant locking experience go as expected for the surgeon.

Question Title

* 6. Rate the implant length selection experience (Check One).

Question Title

* 7. Was the Triple Sleeve System used?

Question Title

* 8. Did the surgeon pin the Triple Sleeve System in place?

Question Title

* 9. Rate the experience using the T-handle Chuck.

Question Title

* 10. Rate the cutting efficiency of the flexible drill.

Question Title

* 11. Did the flexible drill allow for single pass drilling?

T