Post Market Surveillance Form

1. Was the product suitable for intended use?^* 1 - Excellent 2 - Very Good 3 - Good 4 - Average 5 - Poor
2. How easy was the product to use?^* 1 - Very Easy 2 - Easy 3 - Average 4 - Not Easy 5 - Difficult
3. Please rate the quality of the product?^* 1 - Excellent 2 - Very Good 3 - Good 4 - Average 5 - Poor
4. Please rate the packaging of the product?^* 1 - Excellent 2 - Very Good 3 - Good 4 - Average 5 - Poor
5. Did product cause any allergic reaction to patient?^* Yes No
6. Did product cause any discomfort to patient while in use?^* Yes No
7. Completeness of documentation accompanying product (instructions for use, product declaration, etc.)?^* 1 - Excellent 2 - Very Good 3 - Good 4 - Average 5 - Poor

For additional information regarding completion of the questionnaire, please contact Farla Medical Ltd via phone 0345 193 5 193 or email review@farla.co.uk