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Request for more Information and Customer Feedback

If you would like to receive more information on our products or services please complete the brief questionnaire below:

 

 I am a ...

Surgeon

Operating Room Nurse

Materials Manager

Distributor

Other (please specify)

 Customer Information

Name: (required)

Address: (required)

 

 

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Hospital/Business Name(s): (required)

 Customer Feedback

1. I would like to receive information on:

 General

 Vaginal

 Colon/Rectal

 Urological

 Head/Neck

 Plastic/Reconstructive

 

 Other (please specify) 

 Elastic stays products

 Surgical Isolation Bubble System (SIBS)

 Industrial Clean Air Environments Products

 Contract Manufacturing

Comments:

 Customer Feedback

1. The Lone Star Retractor System is currently being used at our
   hospital about     times per month.

2. The Lone Star Retractor System is being used in the following
   areas of surgery:

 General

 Vaginal

 Colon/Rectal

 Urological

 Head/Neck

 Foot

 ENT

 Pediatric

 Plastic

 Other

3. The following surgeons are using the Lone Star Retractor system for the procedures listed:

Surgeon's Name

Procedure

 

 

4. I learned about Lone Star Medical Products through:

 Trade show

 Advertisement

 Referral

 Distributor

 Internet search

 Other

5. Lone Star Medical Products, Inc. would like to hear suggestions from our customers how we may improve our products, service, delivery, or any aspect of our business. Please write your comments or request below:

Comments:

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Lone Star Medical Products, Inc. - a CooperSurgical Company
11211 Cash Road, Stafford, TX 77477, USA
281-340-6010; Fax 281-340-6091

Orders: 800-243-2974; Fax: 800-262-0105

CooperSurgical, Inc., 95 Corporate Dr, Trumbull, CT 06611, USA

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