Breast Surgery POP Box Survey
Please rate how useful you found each item from 1 (Not Useful) to 5 (Can't Live Without It)
(1) Not Useful
(2) Somewhat Useful
(3) Useful
(4) Essential
(5) Can't Live Without It
Did Not Use
Did Not Receive
Gauze
Tape                                                       
Adhesive Remover
Alcohol Swabs                        
Ice Packs                               
Nursing Pads                                 
Miralax                                           
Stain Remover                              
Hard Candy                                 
Tank Tops                                         
Dry Shampoo                               
No-Rinse Body Wash
Deodorant                                   
Lip Balm                                   
Hand Creme                              
Ear Plugs                                
Sleep Mask                                
Cosmetic Bag                             
Drain Kit - Drain Belt / Lanyard
Drain Kit - Shower lanyard
Drain Kit - Gloves
Drain Kit - Measuring Beakers
Drain Kit - Drain Care 101
Drain Kit - Drain Output Log
Hibiclens                                 
Compression band
Overall Rating of Product
1 (Not Useful)
2 (Somewhat Useful)
3 (Useful)
4 (Essential)
5 (Couldn't have done without it)
POP Box
Comments:
Your answer
Is there anything you wish we'd included?
Your answer
If provided by a facility or practice, how would addition of this product influence your likelihood to recommend them?
No Change
Might recommend
Would recommend if asked
Would tell all your friends
Would advertise for them
Likelihood to Recommend Facility
If provided by a facility or practice, how would addition of this product influence your rating of them?
Decrease
No Change
Slight Increase (1-2points/10)
Large Increase (3-4points/10)
Definitely 10 ('Top Box')
Rating Change
How did you find out about us?
What procedure did you use this after?
(Optional; we can't identify respondents)
Your answer
Anything else you'd like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service