Customer Questionnaire

User feedback helps us to maintain and improve the quality of our products.
From meetings with customers or potential customers, valuable information can be obtained. Your opinion and comments are very important to us. Please summarize your experience according to the following guide lines:

Filled by
 End User Distributor Sales Representative



Tel No.*


Details of the product(s) used (model, type, and configuration)

How were Itamar Medical products supplied to the client (directly/agent)?

Did the customer find any defect(s) in the product(s)?

Did any malfunction occur during the use of the product?
(Please provide details, including photos and / or short videos, if available -

Did you get any feedback from patients suffering any discomfort or injury as a result of using our products? (Please provide details, including photos, if available)

Suggestions for improvements and special requests:

Additional Information