Ultrasound Voice of the Customer – Samsung Healthcare USA

Enter Information Below

Samsung Applications Specialist's Name*

First Last

Facility Name*

Facility Contact Name*

Facility Contact Email Address*

Facility Contact Phone Number*

Facility Address, City and State*

Street Address City State

Ultrasound Segment

WH -Ultrasound System

Other

Rad-Ultrasound System*

Other

POC Ultrasound System

Other

Vet Ultrasound System

Other

System Serial Number

System SW Level (helpful to have included, although not required)

Choose Appropriate Topic for Issue*

Other/Miscellaneous*

Enter Transducer Name for Issue Being Reported*

Feature Request*

Issue Being Reported*

How Often is Issue Affecting Workflow*

Other

Customer Satisfaction Impact*