PATIENT SURVEY
Comments
L-23_PIM-BGMP01_Rev 2.0 Copyright © 2019 Preventice Solutions – All rights reserved.
I hereby authorize Preventice Solutions, Inc. to use, reuse, publish or republish my name in light of any communication I made and photographic likeness in all
forms and all media for advertising, marketing, and any other lawful purposes. I release and discharge Preventice Solutions, Inc. from any and all claims and
demands that may arise out of or in connection with the use of photographs, name or likeness, including without limitation any and all claims for libel or violation
of any right of publicity or privacy. I have read this release and fully understand its contents, and I reserve the right to revoke this release upon written request to:
Preventice Solutions, Inc. 1717 N. Sam Houston Parkway West, Suite 100 Houston, Texas 77038
Rate your experience using the monitor and its accessories
1
2
3
4
Setting up the monitor
Wearing and changing the monitor daily
Charging the battery
Adherence and comfort of the Strips (if applicable)
Shipment of supplies for the length of your study
Excellent
Not
applicable
Poor
Average