Position Health Product Evaluation Program Thank you for your interest in Position Health products! PERSONAL INFORMATIONName* First Last Title*Facility Name*CONTACT INFORMATIONFacility Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PhoneEmail Would you like to receive our monthly e-mail bulletin for our product updates and featured clinical articles? Yes No Are you evaluating the TurnAssist Patient Turning System as a nurse/caregiver or as a patient?* Nurse/Caregiver Patient PRODUCT EVALUATEDWhich model of the TurnAssist Patient Turning System did you evaluate?* TurnAssist Premium PTS TurnAssist Standard PTS TurnAssist Bariatric PTS Were you in-serviced on the TurnAssist PTS?* Yes No Were you provided with an information sheet related to the TurnAssist PTS?* Yes No EVALUATE THE TURNASSIST ON THE FOLLOWING: Please rate the following with a score between 1 (Poor) to 5 (Excellent).Ease of applicationPlease enter a value between 1 and 5.Ease of turning the patient side-to-sidePlease enter a value between 1 and 5.Ease of repositioning the patient up and down the bedPlease enter a value between 1 and 5.Effectively positions the patient using the wedgesPlease enter a value between 1 and 5.Protects the patient from shearing and friction injuriesPlease enter a value between 1 and 5.Product accommodates patients' sizePlease enter a value between 1 and 5.Stays in place despite patient movementPlease enter a value between 1 and 5.Provides a comfortable microclimate to help protect the skinPlease enter a value between 1 and 5.Product is durablePlease enter a value between 1 and 5.Represents an improvement over previously used devices or methodsPlease enter a value between 1 and 5.Comfortable when turned side-to-side by caregiverPlease enter a value between 1 and 5.Comfortable when repositioned up and down by caregiverPlease enter a value between 1 and 5.Wedges give comfortable supportPlease enter a value between 1 and 5.Glide sheet allows sufficient air flowPlease enter a value between 1 and 5.Glide sheet and wedges stay in placePlease enter a value between 1 and 5.Additional Comments:PhoneThis field is for validation purposes and should be left unchanged.