Date Started

Interview Date

Interview Start Time

Client: Egg Strategies

3338 Illuminating Physicians'
Job #: Passions
Topic:
Date(s):
Honoraria:

Respondent Start Time

Moderator

First

Last

Phone 1

Phone 2

Call Confirmation Status

Email

City

State

QA. Please select the market research options below

Q1. Your specialty

Q2. Are you board certified

Q3. Number of
years you have
been in practice

Q4.1. Academic
hospital

Q4.2. Community - teaching hospital

Q4.3. Community - non-teaching hospital

Q4.4. VA hospital

Q4.5. Ambulatory Surgery Center (ASC)

Q4.6. Private Practice

Q4.7. Others

Q4.8. Sum Total

Q5.1. Ventral hernia repairs

Q5.2. Abdominal wall reconstructions

Q5.3. Sum Total of hernia repairs

Q6.1. Ventral hernia repairs

Q6.2. Abdominal wall reconstructions

Q7.1. Permanent synthetic mesh

Q7.2. Resorbable synthetic mesh

Q7.3. Biologic mesh

Q7.4. Hybrid of biologic-synthetic

mesh

Q7.5. Sum Total

Q7.6. Sum total of Permanent synthetic

mesh and Resorbable synthetic mesh

Q8.1. In-patient

Q8.2. Out-patient

Q8.3. Sum Total of both

Q9. Are you currently employed by or a consultant for any regulatory agency

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NO
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