BONSS feedback form Surgeon Name:(*) Please enter your name Date(*) ... Please select the date Hospital(*) Please enter your hospital/surgery name. Procedure(*) AdenotonsillectomyTonsillectomyAdenoidectomy Please select a procedure Wand and Technique details: Wand Used(*) Plus 6.0mmHP 4.2mmMax 3.8mm Please enter wand details Technique(*) IntracapsularExtracapsular Please select the technique Existing equipment details: Current equipment used(*) Please enter equipment details What challenges do you have with existing equipment? (*) Please enter challenge details What do you like about existing devices?(*) Please enter what you like about existing devices Thinking about your recent experience, how would you rate the following? 1) Feel / Ergonomics(*) 1) Very Poor2) Poor3) Average4) Good5) Very Good Please enter details about your recent experience 2) Position of saline roller clamp(*) 1) Very Poor2) Poor3) Average4) Good5) Very Good Please enter details about your recent experience 3) Ablative performance(*) 1) Very Poor2) Poor3) Average4) Good5) Very Good Please enter details about your recent experience 4) Coagulation & Haemostasis performance(*) 1) Very Poor2) Poor3) Average4) Good5) Very Good Please enter details about your recent experience 5) Suction Performance(*) 1) Very Poor2) Poor3) Average4) Good5) Very Good Please enter details about your recent experience 6) Speed of use(*) 1) Very Poor2) Poor3) Average4) Good5) Very Good Please enter details about your recent experience Comments about overall performance(*) Please comment on the overall performance Thank you for sharing feedback about BONSS Surgical Electrodes Would you recommend BONSS to a colleague?(*) YesNo Please enter a value Would you be happy to use BONSS Surgical electrodes? (*) YesNo Please enter a value Would you be interested in local education events for either yourself or trainees?(*) YesNo Please enter a value Name of Severn Healthcare representative: Andrew PlumptonOliver DaviesBrett HallPaul WasmuthNitesh PankhaniaRalph Cullinan Please select a name Submit form
