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Questions marked with an * are required Exit Survey
 
 
* What is your Badge ID number?
   
 
 
 
May I take a picture of your badge?
 
Yes
 
No ... I don't have it with me.
 
 
 
Please take the picture of the badge.
 
 
 
Is the picture of the badge clear?
 
Yes
 
No
 
 
 
First Name
   
Last Name
   
Organization / Company Name
   
 
 
 
Email address
   
Zip Code
   
 
 



Contact Additional Information
 
 
 
* What is your role?
 
Manager and Above
 
Staff RN
 
Educator
 
Other
 
 
 
 
Are you interested in?
 
Anesthesia and Critical Care Products
 
BioSurgery Products
 
Both
 
 
 


Product section: BioSurgery
 
 
 
What Brands would you like to learn more about?
 
FLOSEAL
 
TISSEEL
 
COSEAL
 
TACHOSIL
 
Other
 

 
 
 
* Would you be interested in having a representative contact you to set up an in-service?
 
YES
 
NO
 
 
 
When would you consider hosting this in-service event?
 
Next Week
 
Within a Month
 
3-6 Months
 
6 Months or more
 
 
 


Product section: ACC
 
 
 
What Brands are you most interested in?
 
TRANSDERM SCOP
 
SUPRANE
 
Other
 

 
 
 
* Do you currently use Baxter's Anesthesia products in your hospital?
 
YES
 
NO
 
Do not know
 
 
 
* Does your hospital currently have a protocol for PONV?
 
YES
 
NO
 
Do not know
 
 
 



 Communication Preferences
 
 
 
Would you like a Sales Representative to contact you for something other than an "In Service"?
 
Yes
 
No
 
 
Communication preference options:
Yes No
* Phone
* Email
 
 
 
* Phone # (Numbers Only)
   
 
 
 
Would you like to receive future emails from Baxter?
 
Yes
 
No
 
 
 
Interviewer Comments