Customer Satisfaction Survey

* Indicates required information
Physician Name *
Practice Name
Board Specialty *
Email Address *
Street, Apt./Suite
City, State/Province *
Zip/Postal Code, Country
Daytime Phone (including area code) *
Alternate Phone
Alternate Email
Fax
Website

Preferred Method of Communication (please check one): Phone
Email
Mail
Fax

Please answer the following questions: 1. On average how many VASER Lipo Procedures do you perform each month? Below 3
3 - 6
7 - 10
10 +

2. Where do you primarily perform VASER Lipo procedures? Office
Surgery Center
Hospital

3. Do you use the VASER Lipo System for all of your body contouring procedures? Yes
No

If you chose NO, what other technology do you use and why?

4. What form(s) of anesthesia do you use to perform VASER Lipo?
(please check all that apply) General
IV Sedation
Local Tumescent

5. What areas of the body do you treat with the VASER System?
(please check all that apply) Abdomen
Thighs
Calves
Ankles
Knees
Buttocks
Waist/Hips
Female Breasts
Gynecomastia
Chin/Neck
Face
Back
Arms
Superficial Treatments

Other (Explain Below)

6. Have you ever used the VASER Lipo System to treat Axillary Hyperhidrosis? Yes
No

7. Have you ever used VASER emulsified fat in fat transfer procedures? Yes
No

8. Would you like additional training on the VASER System? Yes
No

9. If an opportunity becomes available, would you like to become more involved in new clinical applications, physician education or peer advocacy efforts for the VASER Lipo System? Yes
No

If you circled YES, what areas would you like to be involved in?
(please check all that apply) Physician Referral Network
Speaking Events
White Papers/ Clinical Series
Clinical Studies
Physician Training
Media Spokesperson

10. Would you be willing to share your VASER before and after photographs for use in educational and marketing materials? Yes
No

11. Please indicate how often you experience the following VASER System benefits: a. Fast patient recovery/reduced downtime Never
Rarely
Sometimes
Often
Always

b. Minimal pain / less pain medication required Never
Rarely
Sometimes
Often
Always

c. Minimal bruising Never
Rarely
Sometimes
Often
Always

d. Reduced need for re-treatments Never
Rarely
Sometimes
Often
Always

e. Smooth, predictable results Never
Rarely
Sometimes
Often
Always

f. Skin Tightening Never
Rarely
Sometimes
Often
Always

g. Increased precision/ greater ability to sculpt Never
Rarely
Sometimes
Often
Always

h. Reduced physician fatigue Never
Rarely
Sometimes
Often
Always

12. How would you rate your overall satisfaction with the customer support provided by SST?
(Please rate each of the following from 1-10, 10 being the best) a. Customer Service

b. Technical Service

c. Marketing Support How can we improve our customer support program?

13. How would you rate your satisfaction with the VASER Lipo System? a. Technology Performance

b. Clinical Outcomes

c. Value

d. Positive Impact on Practice How can we improve the VASER® Lipo System?

14. How likely are you to refer VASER Technology to another physician or facility? Not Likely
Likely
Very Likely

Thank you for taking the time to complete this survey.
Your feedback is of great importance to us!