1. Why did you use ImPad One on this patient?

DVT Prophylaxis

Oedema Management

Other (Please State)

2. How long did the patient use ImPad One (Days)?

1

2

3

4

5

>5

3. How long did the patient use ImPad One (Hours)?

1-5

6-10

11-24

25-36

37-48

48-72

4. How many times was ImPad One re-fitted during the treatment?

1-3

4-5

6-10

11-20

21-30

30+

5. The Instructions for Use were easy to follow

Agree

Disagree

6. The ImPad One was easy to apply

Agree

Disagree

7. The ImPad One was easy to remove

Agree

Disagree

8. The patient found the ImPad One comfortable and there were no issues with skin integrity

Agree

Disagree

9. What did you like the most about ImPad One?

10. What did you like the least about ImPad One?

11. How could ImPad One be improved?

12. General Comments

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Name & Surname

Job Title

Department

Hospital

Phone/Fax/Email