Post-Surgical Bras Product Evaluation

We value your opinion

We appreciate your input on the Dale Post-Surgical Bras.

Please answer the following questions:

701-706 | Post-Surg Bra Evaluation Form

Did you have the opportunity to use the Dale Post-Surgical Bra on a Patient?

Yes

Where was the procedure performed?

Hospital

Doctor's Office

Surgicenter

When was the Dale Post-Surgical Bra given to the patient?

Prior to the procedure

After the procedure

How long did your patient wear the Dale Post-Surgical Bra for?

days

Did the Dale Post-Surgical Bra provide adequate compression?

Yes

Do you currently supply a post-surgical bra for your patients?

Yes

Would you recommend this product for regular use in your facility?

Yes

Please cite any additional comments you may have:

Salutation

First Name

Last Name

Job Title

Facility

Phone/Mobile

Department

Address

Address Line 1

Address Line 2

City

State

Zip Code

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Please contact me

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