ROLE and RANKING (*do not input name)
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First Name
Last Name
Email
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DATE OF CLASS and ROSTER NUMBER
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Which product did you use?
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Field Shield Wound Dressing (silver + lidocaine)
Advanced Seal plus Pain (Lidocaine)
Advanced Shield MAX (Silver)
Are you a medic or a non-medic operator? What is your TCCC Tier #?
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Who presented you with the product and instructed you on how to use it?
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Instructor? Peer? Medic/Higher? Self?
What type of wound did you use the dressing on?
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Did you understand what the product was from looking at the bottle? If not, any ways to improve?
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Did you easily know how to use the product? If not, any ways to improve?
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Was the product easy to apply/administer?
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Was the bottle easy to grip and use?
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Did the product cover the entire treatment area? Was there enough of the product to cover the entire wound in excess?
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Did bottle function when your hands were wet or dirty?
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Yes, No, or N/A
Did you apply a secondary dressing over the spray? If so, did you allow the product to dry before covering with the secondary dressing?
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Would you consider this product effective for field use for wound care?
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Was the product easy to carry in the field? Could you easily identify it in your bag?
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Could you see yourself using this in austere environments?
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Do you think using this product will help you return to service faster and stay operational longer?
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Additional comments or testimonial appreciated!
Would you be interested in receiving more information about the products or how to order?
If yes, please include your name in the field above.
Thank you for taking the time to provide us with your valuable feedback. An email will be sent to you with your eGift card from Amazon.
If you have any additional questions or would like to contact us, please reach out to Anita at sales@kericuremedical.com.
Best regards,
KeriCure Team
