CUSTOMER X-SURGE QUESTIONNAIRE

Please take a moment to complete this questionnaire. Our aim is to understand product performance in your market to improve our products and services.

For each question, please select the option that best describes your opinion. Choose from poor to excellent, or N/A if the question is not relevant to your experiences. Feel free to add any comments for each section or at the end of the questionnaire.

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* 1. Completed By

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* 2. On Behalf Of

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* 3. Category of Qualification

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* 4. If you answered Surgeon in the previous question, please select a specialty subcategory.

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* 5. How were the answers acquired ?

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* 6. Which product did you use?

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