BAPTIST MED CENTER SOUTH

Name*

First Last

Date*

MM

DD

YYYY

Facility*

Department*

Were you in-serviced?*

Have you used Shower Shield on a patient?*

Was Shower Shield easy to apply and remove?*

Did the Shower Shield keep the dressing dry during showering or sponge bathing?*

Is Shower Shield more effective than the current practice?*

Will Shower Shield save time and promote hygiene?*

Overall, would you recommend the use of Shower Shield?*

Was the patient satisfied with Shower Shield?*

Would you like Shower Shield to be available in your hospital?*

Additional Comments

Phone

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Interested in Shower Shield products?