Request Information
Date: 3/14/2010
Contact Information:
Contact Name:
Contact Title/Job Description:
Central Supply/Central Service
Dental
Emergency Department
Emergency Services
Engineering
Enterostomal Therapist
Gastroenterologists
Laboratory
Industrial Hygiene
Interventional Radiologist
Materials Management/Purchasing
Nurse Educator
Perioperative Nurse
Quality Improvement
Registered Dietician
Registered Nurse
Respiratory Therapy
Risk Management
Surgeon
Other
If other, please specify:
Contact Email:
Contact Phone:
Facility Name:
Facility Address:
Facility City:
Facility State:
Facility Zip:
Would you like to receive electronic updates on healthcare topics from Kimberly-Clark? Yes
No
If Yes, which particular fields are you most interested in (check all that apply)?
Surgical Issues
Sterilization Issues
Glove Related Issues
Medical Device Issues
Infection Control Issues
Managerial Issues
Would you be willing to participate in online market research regarding healthcare topics? Yes
No
Comments: