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* 1. Contact Information

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* 2. Please indicate what products you are reporting on. If reporting on more than one product range, please provide separate reports.

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* 3. Using the scale below, please rate the following

  Poor Fair Average Good Excellent
Product Quality
Clinical Results
Instructions and Labelling
Product Packaging
Delivery Performance
Documentation and Administration
Marketing Materials
Overall Products/Service

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* 4. Please answer 'yes' or 'no' to the following;

  Yes No
Are you satisfied with the surgical technique?
Did you experience any problems or difficulties when using the device?
Does the device meet the intended use?
Have you received any unreportable complaints in the last 12 months?

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* 5. Are you aware of any new/changes in the existing clinical uses/techniques? (Please supply details as an addendum to this report)

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* 6. Are you aware of any new contraindications or side effects? (Please supply details as an addendum to this report)

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* 7. Are you aware of any new clinical monitoring (X-Rays/CT data, other follow-up) that could add to our Post Market Surveillance? (Please supply details as an addendum to this report)

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* 8. Are you willing to collaborate with any clinical monitoring in the next 12 months?

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* 9. Do you have any other comments, questions or concerns?

Osteotec are committed to maintaining and continually improving a quality system that meets and exceeds customer expectations. Thank you for completing and returning this survey.                                                                                                                
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