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Dear customer,

In order to obtain information about the equipment marketed by Haag-Streit AG as required by various regulations, we are dependent on your assistance.

We would like to ask you to take a moment to answer the questions formulated in the following questionnaire. This will help us to identify possible risks in the use of our equipment at an early stage and to remedy them if necessary. In addition, the answers will enable us to develop and produce our devices even more safely for you and your patients/customers in the future.

Your data collected in the course of this survey will of course be treated confidentially and will not be passed on to third parties.

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* 1. Contact details

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* 2. Device identification

Which Slit lamp from Haag-Streit AG do you have in use?

Usability

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* 3. How satisfied are you with the ergonomics of the device?

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* 4. How satisfied are you with the use of the device?

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* 5. Have you ever made had any mistakes in connection with too complicated application procedures?

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* 6. What suggestions for improvement do you have for using the Slit lamp?

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* 7. How understandable is the supplied instruction manual for your Slit lamp?

Diagnostic capability

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* 8. Do you receive the expected results during the examination with your Slit lamp?

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* 9. Have you ever received incorrect data due to improper use of your slit lamp?

Residual risks

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* 10. Have you had any technical problems with your slit lamp in the past?

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* 11. Has this led to a bad result, effects on patients?

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* 12. Did you ever had an issue with your Slit lamp which led to a injury for you or one of your patients?

General impression

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* 13. What is your general impression of the Haag-Streit Slit lamp?

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* 14. Do you have anything else you would like to tell us?

We thank you for your participation in this short survey. With your help we can constantly improve our products and get the best out of our equipment for you as a customer.

If you have any further questions to our products, please contact our customer support under service@haag-streit.com

Yours sincerely

 Haag-Streit Diagnostics AG
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