Manual Entry Customer Questionnaire Rev C Survey

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* 3. Category of Qualification

Distributor

Hospital Administrator

Sales Representative

Surgeon

Nurse

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

General

Pediatric

Gynecology

Urology

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* 5. How were the answers acquired ?

Telephone Call

Hospital Visit

Office Visit

Email received

Other (please specify)

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

	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

Other (please specify)

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

	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

Other (please specify)

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

	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

Other (please specify)

Question Title

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

	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

Other (please specify)

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

Yes

Other (please specify)

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

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Other (please specify)

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

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Poor

Unsatisfactory

Indifferent

Satisfactory

Excellent

N/A

Other (please specify)

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* 13. File Upload

You have the opportunity to upload files relevant to this survey

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Manual Entry Customer Questionnaire Rev C

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

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

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

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

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

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

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

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* 13. File Upload