PATIENT SURVEY
Comments
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 accessories
1
2
3
4
Setting up the monitor
Wearing and charging the monitor
Adherence and comfort of the Strips
Shipment of supplies for the length of your study
Excellent
Not
applicable
Poor
Average
L-19A_PIM-BGM02EN_Rev 7.0 Copyright © 2021 Preventice Solutions – All rights reserved.
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