Manual Entry Customer Questionnaire Rev C Survey

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.

	Poor	Unsatisfactory	Indifferent	Satisfactory	Excellent	N/A
Bladeless Ports ( Natura, GeniLook, GeniPalm)	Bladeless Ports ( Natura, GeniLook, GeniPalm) Poor	Bladeless Ports ( Natura, GeniLook, GeniPalm) Unsatisfactory	Bladeless Ports ( Natura, GeniLook, GeniPalm) Indifferent	Bladeless Ports ( Natura, GeniLook, GeniPalm) Satisfactory	Bladeless Ports ( Natura, GeniLook, GeniPalm) Excellent	Bladeless Ports ( Natura, GeniLook, GeniPalm) N/A
Shielded Ports ( GeniShield)	Shielded Ports ( GeniShield) Poor	Shielded Ports ( GeniShield) Unsatisfactory	Shielded Ports ( GeniShield) Indifferent	Shielded Ports ( GeniShield) Satisfactory	Shielded Ports ( GeniShield) Excellent	Shielded Ports ( GeniShield) N/A
Blunt Ports ( Hasson)	Blunt Ports ( Hasson) Poor	Blunt Ports ( Hasson) Unsatisfactory	Blunt Ports ( Hasson) Indifferent	Blunt Ports ( Hasson) Satisfactory	Blunt Ports ( Hasson) Excellent	Blunt Ports ( Hasson) N/A
Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee )	Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Poor	Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Unsatisfactory	Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Indifferent	Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Satisfactory	Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Excellent	Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) N/A
Veress Needle ( GeniFirst)	Veress Needle ( GeniFirst) Poor	Veress Needle ( GeniFirst) Unsatisfactory	Veress Needle ( GeniFirst) Indifferent	Veress Needle ( GeniFirst) Satisfactory	Veress Needle ( GeniFirst) Excellent	Veress Needle ( GeniFirst) N/A
Ligation ( GeniClip, A Li-Gator)	Ligation ( GeniClip, A Li-Gator) Poor	Ligation ( GeniClip, A Li-Gator) Unsatisfactory	Ligation ( GeniClip, A Li-Gator) Indifferent	Ligation ( GeniClip, A Li-Gator) Satisfactory	Ligation ( GeniClip, A Li-Gator) Excellent	Ligation ( GeniClip, A Li-Gator) N/A
Monopolar ( GeniSurge, NanoSurge)	Monopolar ( GeniSurge, NanoSurge) Poor	Monopolar ( GeniSurge, NanoSurge) Unsatisfactory	Monopolar ( GeniSurge, NanoSurge) Indifferent	Monopolar ( GeniSurge, NanoSurge) Satisfactory	Monopolar ( GeniSurge, NanoSurge) Excellent	Monopolar ( GeniSurge, NanoSurge) N/A
Bipolar (BiSurge)	Bipolar (BiSurge) Poor	Bipolar (BiSurge) Unsatisfactory	Bipolar (BiSurge) Indifferent	Bipolar (BiSurge) Satisfactory	Bipolar (BiSurge) Excellent	Bipolar (BiSurge) N/A
Suction irrigation ( GeniFlow, PowerFlow)	Suction irrigation ( GeniFlow, PowerFlow) Poor	Suction irrigation ( GeniFlow, PowerFlow) Unsatisfactory	Suction irrigation ( GeniFlow, PowerFlow) Indifferent	Suction irrigation ( GeniFlow, PowerFlow) Satisfactory	Suction irrigation ( GeniFlow, PowerFlow) Excellent	Suction irrigation ( GeniFlow, PowerFlow) N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Bladeless Ports ( Natura, GeniLook, GeniPalm)

Bladeless Ports ( Natura, GeniLook, GeniPalm) Poor

Bladeless Ports ( Natura, GeniLook, GeniPalm) Unsatisfactory

Bladeless Ports ( Natura, GeniLook, GeniPalm) Indifferent

Bladeless Ports ( Natura, GeniLook, GeniPalm) Satisfactory

Bladeless Ports ( Natura, GeniLook, GeniPalm) Excellent

Bladeless Ports ( Natura, GeniLook, GeniPalm) N/A

Shielded Ports ( GeniShield)

Shielded Ports ( GeniShield) Poor

Shielded Ports ( GeniShield) Unsatisfactory

Shielded Ports ( GeniShield) Indifferent

Shielded Ports ( GeniShield) Satisfactory

Shielded Ports ( GeniShield) Excellent

Shielded Ports ( GeniShield) N/A

Blunt Ports ( Hasson)

Blunt Ports ( Hasson) Poor

Blunt Ports ( Hasson) Unsatisfactory

Blunt Ports ( Hasson) Indifferent

Blunt Ports ( Hasson) Satisfactory

Blunt Ports ( Hasson) Excellent

Blunt Ports ( Hasson) N/A

Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee )

Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Poor

Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Unsatisfactory

Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Indifferent

Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Satisfactory

Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) Excellent

Specimen Retrieval Bags (GeniStrong, SimplyStrong, Ezee ) N/A

Veress Needle ( GeniFirst)

Veress Needle ( GeniFirst) Poor

Veress Needle ( GeniFirst) Unsatisfactory

Veress Needle ( GeniFirst) Indifferent

Veress Needle ( GeniFirst) Satisfactory

Veress Needle ( GeniFirst) Excellent

Veress Needle ( GeniFirst) N/A

Ligation ( GeniClip, A Li-Gator)

Ligation ( GeniClip, A Li-Gator) Poor

Ligation ( GeniClip, A Li-Gator) Unsatisfactory

Ligation ( GeniClip, A Li-Gator) Indifferent

Ligation ( GeniClip, A Li-Gator) Satisfactory

Ligation ( GeniClip, A Li-Gator) Excellent

Ligation ( GeniClip, A Li-Gator) N/A

Monopolar ( GeniSurge, NanoSurge)

Monopolar ( GeniSurge, NanoSurge) Poor

Monopolar ( GeniSurge, NanoSurge) Unsatisfactory

Monopolar ( GeniSurge, NanoSurge) Indifferent

Monopolar ( GeniSurge, NanoSurge) Satisfactory

Monopolar ( GeniSurge, NanoSurge) Excellent

Monopolar ( GeniSurge, NanoSurge) N/A

Bipolar (BiSurge)

Bipolar (BiSurge) Poor

Bipolar (BiSurge) Unsatisfactory

Bipolar (BiSurge) Indifferent

Bipolar (BiSurge) Satisfactory

Bipolar (BiSurge) Excellent

Bipolar (BiSurge) N/A

Suction irrigation ( GeniFlow, PowerFlow)

Suction irrigation ( GeniFlow, PowerFlow) Poor

Suction irrigation ( GeniFlow, PowerFlow) Unsatisfactory

Suction irrigation ( GeniFlow, PowerFlow) Indifferent

Suction irrigation ( GeniFlow, PowerFlow) Satisfactory

Suction irrigation ( GeniFlow, PowerFlow) Excellent

Suction irrigation ( GeniFlow, PowerFlow) N/A

	Poor	Unsatisfactory	Indifferent	Satisfactory	Excellent	N/A
Shipping Cartons	Shipping Cartons Poor	Shipping Cartons Unsatisfactory	Shipping Cartons Indifferent	Shipping Cartons Satisfactory	Shipping Cartons Excellent	Shipping Cartons N/A
Shelf Boxes	Shelf Boxes Poor	Shelf Boxes Unsatisfactory	Shelf Boxes Indifferent	Shelf Boxes Satisfactory	Shelf Boxes Excellent	Shelf Boxes N/A
Individual Units	Individual Units Poor	Individual Units Unsatisfactory	Individual Units Indifferent	Individual Units Satisfactory	Individual Units Excellent	Individual Units N/A
Insert cards	Insert cards Poor	Insert cards Unsatisfactory	Insert cards Indifferent	Insert cards Satisfactory	Insert cards Excellent	Insert cards N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Shipping Cartons

Shipping Cartons Poor

Shipping Cartons Unsatisfactory

Shipping Cartons Indifferent

Shipping Cartons Satisfactory

Shipping Cartons Excellent

Shipping Cartons N/A

Shelf Boxes

Shelf Boxes Poor

Shelf Boxes Unsatisfactory

Shelf Boxes Indifferent

Shelf Boxes Satisfactory

Shelf Boxes Excellent

Shelf Boxes N/A

Individual Units

Individual Units Poor

Individual Units Unsatisfactory

Individual Units Indifferent

Individual Units Satisfactory

Individual Units Excellent

Individual Units N/A

Insert cards

Insert cards Poor

Insert cards Unsatisfactory

Insert cards Indifferent

Insert cards Satisfactory

Insert cards Excellent

Insert cards N/A

	Poor	Unsatisfactory	Indifferent	Satisfactory	Excellent	N/A
Sales Representatives	Sales Representatives Poor	Sales Representatives Unsatisfactory	Sales Representatives Indifferent	Sales Representatives Satisfactory	Sales Representatives Excellent	Sales Representatives N/A
Customer Service Reps	Customer Service Reps Poor	Customer Service Reps Unsatisfactory	Customer Service Reps Indifferent	Customer Service Reps Satisfactory	Customer Service Reps Excellent	Customer Service Reps N/A
Order Acknowledgements	Order Acknowledgements Poor	Order Acknowledgements Unsatisfactory	Order Acknowledgements Indifferent	Order Acknowledgements Satisfactory	Order Acknowledgements Excellent	Order Acknowledgements N/A
Delivery Times	Delivery Times Poor	Delivery Times Unsatisfactory	Delivery Times Indifferent	Delivery Times Satisfactory	Delivery Times Excellent	Delivery Times N/A
General Inquiries ( Pricing, Bids, etc. )	General Inquiries ( Pricing, Bids, etc. ) Poor	General Inquiries ( Pricing, Bids, etc. ) Unsatisfactory	General Inquiries ( Pricing, Bids, etc. ) Indifferent	General Inquiries ( Pricing, Bids, etc. ) Satisfactory	General Inquiries ( Pricing, Bids, etc. ) Excellent	General Inquiries ( Pricing, Bids, etc. ) N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Sales Representatives

Sales Representatives Poor

Sales Representatives Unsatisfactory

Sales Representatives Indifferent

Sales Representatives Satisfactory

Sales Representatives Excellent

Sales Representatives N/A

Customer Service Reps

Customer Service Reps Poor

Customer Service Reps Unsatisfactory

Customer Service Reps Indifferent

Customer Service Reps Satisfactory

Customer Service Reps Excellent

Customer Service Reps N/A

Order Acknowledgements

Order Acknowledgements Poor

Order Acknowledgements Unsatisfactory

Order Acknowledgements Indifferent

Order Acknowledgements Satisfactory

Order Acknowledgements Excellent

Order Acknowledgements N/A

Delivery Times

Delivery Times Poor

Delivery Times Unsatisfactory

Delivery Times Indifferent

Delivery Times Satisfactory

Delivery Times Excellent

Delivery Times N/A

General Inquiries ( Pricing, Bids, etc. )

General Inquiries ( Pricing, Bids, etc. ) Poor

General Inquiries ( Pricing, Bids, etc. ) Unsatisfactory

General Inquiries ( Pricing, Bids, etc. ) Indifferent

General Inquiries ( Pricing, Bids, etc. ) Satisfactory

General Inquiries ( Pricing, Bids, etc. ) Excellent

General Inquiries ( Pricing, Bids, etc. ) N/A

	Poor	Unsatisfactory	Indifferent	Satisfactory	Excellent	N/A
Instructions for Use ( e- IFU)	Instructions for Use ( e- IFU) Poor	Instructions for Use ( e- IFU) Unsatisfactory	Instructions for Use ( e- IFU) Indifferent	Instructions for Use ( e- IFU) Satisfactory	Instructions for Use ( e- IFU) Excellent	Instructions for Use ( e- IFU) N/A
Literature Pieces and Catalog	Literature Pieces and Catalog Poor	Literature Pieces and Catalog Unsatisfactory	Literature Pieces and Catalog Indifferent	Literature Pieces and Catalog Satisfactory	Literature Pieces and Catalog Excellent	Literature Pieces and Catalog N/A
Website ( www.geniconendo.com)	Website ( www.geniconendo.com) Poor	Website ( www.geniconendo.com) Unsatisfactory	Website ( www.geniconendo.com) Indifferent	Website ( www.geniconendo.com) Satisfactory	Website ( www.geniconendo.com) Excellent	Website ( www.geniconendo.com) N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Instructions for Use ( e- IFU)

Instructions for Use ( e- IFU) Poor

Instructions for Use ( e- IFU) Unsatisfactory

Instructions for Use ( e- IFU) Indifferent

Instructions for Use ( e- IFU) Satisfactory

Instructions for Use ( e- IFU) Excellent

Instructions for Use ( e- IFU) N/A

Literature Pieces and Catalog

Literature Pieces and Catalog Poor

Literature Pieces and Catalog Unsatisfactory

Literature Pieces and Catalog Indifferent

Literature Pieces and Catalog Satisfactory

Literature Pieces and Catalog Excellent

Literature Pieces and Catalog N/A

Website ( www.geniconendo.com)

Website ( www.geniconendo.com) Poor

Website ( www.geniconendo.com) Unsatisfactory

Website ( www.geniconendo.com) Indifferent

Website ( www.geniconendo.com) Satisfactory

Website ( www.geniconendo.com) Excellent

Website ( www.geniconendo.com) N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Manual Entry Customer Questionnaire Rev C

CUSTOMER QUESTIONNAIRE

* 1. Completed By

* 2. On Behalf Of

* 3. Category of Qualification

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

* 5. How were the answers acquired ?

* 6. How would you rate the performance of the following products in the Operating Room ?

* 7. How would you rate the packaging of the products ?

* 8. How would you rate the support received from your contact with GENICON ?

* 9. How would you rate the following Marketing or Informational materials ?

* 10. Have you ever filed a complaint concerning any GENICON products ?

* 11. How would you rate the speed at which the complaint was handled ?

* 12. How would you rate the quality of the response and solution to the complain?

* 13. File Upload