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CleanPatch Product Feedback

CleanPatch fixed

Name: *
Prefix
First *
Last *
Suffix
MI
Middle
Email: *
Title: *
Facility name *
What type of surface(s) did you apply CleanPatch to? *
 Mattress 
 Stretcher  
 Other  
(If other, please enter surface type in next question)
What colour and/or model was the surface?
(Please fill in all known information)
Please identify the characteristics of the surface? *
 Foam core 
 Air filled  
 Unknown  
How long was your CleanPatch evaluation?
 0-30 days 
 30-90 days 
 90+ days  
Ease of CleanPatch application *
 NA 
 0 
 1 
 2 
 3 
 4 
 5 
0=Very difficult 5=Very easy
How satisfied are you with the performance of CleanPatch? *
 NA 
 0 
 1 
 2 
 3 
 4 
 5 
0=Very dissatisfied 5=Very satisfied
Upload photo of damage or repair
Information about photo
How would you rate the CleanPatch support from your local Distributor? *
 NA 
 0 
 1 
 2 
 3 
 4 
 5 
 I don't know who my distributor is 
0=Low 5=High
Are you interested in implementing Mattress Inspection and Repair using CleanPatch in your facility? *
 Yes  
 No 
(If yes, we will contact you with additional information)
Is there a colleague you would like us to contact regarding CleanPatch?
Prefix
First
Last
Suffix
MI
Middle
Email address
Is there anything we could improve on or additional information?

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