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* 1. Country

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* 2. Facility

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* 3. Product Used

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* 4. Item Number(s) Used

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* 5. Procedure(s) Performed

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* 6. Anatomy Targeted

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* 7. Rate satisfaction on a scale of 1 to 5 (1 being the lowest level of satisfaction & 5 being the highest level of satisfaction)

  1-Low Satisfaction 2 3 4 5-High Satisfaction
Rate the ease of assembly of the bracket and needle guide.
Based on product design, rate the ease of use of the needle guide during the procedure.
How satisfied are you with the quality of this product?
How well did the guide enable in-plane needle guidance compared to expectations?

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* 8. Based on your clinical expertise, do you believe there is added patient risk associated with the use of this guidance product?

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* 9. Which ultrasound cover was used during the needle guided procedure?

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* 10. How well did the ultrasound cover serve as a sterile barrier? (Rank satisfaction with 1 being the lowest and 5 being the highest)

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* 11. Please provide your email address in order for CIVCO to respond to any concerns.

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