Lifebox: Saving lives through safer surgery

Name

Email

Client ID

Please confirm the following details:

Was the oximeter and the contents intact and fully functioning?

• Oximeter
  yes no 
• Probe
  yes no 
• Charger
  yes no 
• Rechargeable batteries
  yes no 
• CD
  yes no 

Please tell us about any problems or questions you have at this time:
---Oximeter does not workOximeter does not chargeProbe is brokenEducation CD Rom will not play
Other:

Will the oximeter primarily be used in:
---Operating theatreIntensive care wardNeonatal unit
Other:

Would you recommend Lifebox to a colleague?
yes no 
Please comment:

Please provide the contact details of a colleague who might be interested in purchasing a Lifebox oximeter

Name

Title

Facility

Email

Mobile phone number

Please provide two contacts for feedback update in 6 months time (Name, Address and Email address):

Contact 1


Contact 2