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Enter your contact information |
*First name: |
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*Last name: |
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*Email address: |
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Address: |
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City: |
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State: |
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Zip: |
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Phone number: |
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Best time to reach you: |
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Share your story |
Your relationship to da Vinci® surgery. |
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Patient/caregiver or family member |
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Friend of patient/surgeon |
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Family physician/other |
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What was your condition? |
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Type of procedure you had? |
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Date of procedure? |
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Your surgeon’s name? |
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Hospital where you had your surgery? |
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We’d like to know more about how you made your
decision and about your experience. Please share with us by
answering the following questions: |
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What other treatments did you consider, if any? |
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What were your biggest concerns about treatment? |
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What made you choose da Vinci® surgery? |
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How long were you in the hospital? |
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Did you have pain or discomfort? |
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How long was your recovery? |
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When did you return to normal activities? |
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What did you think about the care you received
from your surgeon? |
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What did you think about the care you received
from the facility’s staff? |
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How does this compare to your previous experiences
or preconceptions of surgery? |
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Would you recommend da Vinci® surgery to
a friend or family member? |
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How did you hear about us? |
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da Vinci® surgery website |
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Friend or family member |
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Intuitive Surgical representative |
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My hospital |
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My surgeon |
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Family physician |
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Other |
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Please upload a picture of yourself |
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