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Track your CleanPatch Trial

Have you received a CleanPatch sample and are eager to trial it at your Facility?

In our experience, beds and stretchers move about healthcare facilities and it is sometimes difficult to track your mattress repaired with CleanPatch. We have developed a three Step approach in order to help track the performance on CleanPatch in your facility.

Step 1 - Apply CleanPatch to a damaged mattress or soft surface.

Step 2 - Mark the bedframe with a tag or sticker. This provides an easy visual cue to find the repair at the end of the trial.

Step 3 - Track your CleanPatch by filling out the form below, we will send you a reminder at the end of the trial!

At the completion of your CleanPatch Trial it would be greatly appreciated if you would fill out a short Customer Satisfaction Survey.

 
Full Name *
Email: *
Facility name: *
What type of surface did you apply CleanPatch to? *
 Mattress 
 Stretcher 
 Other 
In what Department is the CleanPatch trial occurring? *
(Example - OR, Radiology, ICU, 5th Floor Unit)
What is the Room and Bed number that CleanPatch was applied to? *
Did you attach a tracking label to the bedframe or equipment?
 Yes 
 No 
How long would you like to trial CleanPatch?
 30 days 
 60 days 
(CleanPatch has been proven in dozens of facilities to be durable for at least one year, we recommend a 30 day trial)
Local Distributor Name:
(if applicable)

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