3M Cavilon™ No-Rinse Skin Cleanser 3380 Template

3M

™

Cavilon

™

No-Rinse Skin Cleanser

Name of Evaluator Title Health Care Facility Name Sales Representative Phone Number Date Department Do you currently use a liquid skin cleanser?

Yes No If so, which brand? ____________________________________________________________________________ Compared to your usual cleanser – How effective is Cavilon No-Rinse Skin Cleanser at cleaning stool?

How effective is Cavilon No-Rinse Skin Cleanser at cleaning other soil?

Rate the gentleness of Cavilon No-Rinse Skin Cleanser Rate the “after-feel” of Cavilon No-Rinse Skin Cleanser Rate the scent of Cavilon No-Rinse Skin Cleanser Rate the overall performance of Cavilon No-Rinse Skin Cleanser Better Than Equal To Worse Than Not applicable Additional Comments ___________________________________________________________________________________________ _________________________________________________________________________________________________________________ Would you recommend your facility purchase Cavilon No-Rinse Skin Cleanser?

Definitely Probably No If no, please explain: ____________________________________________________

Please complete and return this evaluation form to your 3M Critical & Chronic Care Solutions Representative.

Critical & Chronic Care Solutions Division 3M Health Care

2510 Conway Avenue St. Paul, MN 55144 USA 1-800-228-3957 www.3M.com/Cavilon 3M and Cavilon are trademarks of 3M.

Please recycle. Printed in U.S.A.

© 3M 2013. All rights reserved.

70-2010-8292-5