DISTRIBUTOR FEEDBACK FORM
Name & Items of The Products used
Date
Number of Delivery Received
HOWs DO YOU RATE THE FOLLOWING IN AMPL PRODUCT (Please mark √ in the desired grading)
PARAMETERS
GRADING
Product Performance
Excellent
Very Good
Good
Average
Need Improvement
Please elaborate, If needs improvement
Quality
Perfromance (Fitment & Functional)
Product Presentation
PARAMETERS
GRADING
Product Presentation
Excellent
Very Good
Good
Average
Needs Improvement
Please elaborate, If needs improvement
Packaging
Instruction for use
Brochures
Catalog
Product Range
Service
PARAMETERS
GRADING
Product Service
Excellent
Very Good
Good
Average
Needs Improvement
Please elaborate, If needs improvement
Promptness in a attending requests, Mails/Calls
Adherence to delivery schedule
Delivery method includes options to choose
Resolution of complaints
Clarity in information supplied
Price competitiveness
Other Spacify
Receipt of the Product
Would you consider referring Auxein products to known surgeons of other portfolios also?
Name *
Mobile/Tel. No. *
Address *
E-mail ID *
Signature of the Distributor/ Dealer /User/ Field Rep *
Stamp of the Distributor/ Dealer *
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