Questionnaire for market observation
Port catheter systems

Costumer feedback form - patient

Dear Sir or Madam,

Against the background above, we are dependent on your support within the framework of the practical implementation of the EU Regulation 2017/745 enacted by the European Parliament and the Council.

Feedback by patients and former patients who are or have been into contact with our products and can thus adequately evaluate them is particularly helpful to us.
The evaluation of your answers is anonymous and no conclusions about individual patients are included in the corresponding evaluation.

The questionnaire is divided into the following topics:

I. Information about the patient
II. Product Information
III. Information about treatment
IV. Information about the implant (port catheter system)
V. General information

We kindly ask you to take a few moments to answer the questionnaire. The questionnaire will take about 5-10 minutes to complete.
Your answers will help us to improve medical products in the future, to make them even safer and to make them available in the usual form.

Thank you very much for your support!
The team of PakuMed gmbh


PakuMed medical products gmbh

Im Löwental 79
45239 Essen

Phone: +49 201 – 43 70 97 – 0
**If you have a port catheter system implanted from the manufacturer PakuMed medical products GmbH (Essen, Germany) you will find the information on the article no. and Lot in your implant card.
Satisfaction (0 = Not at all satisfied, 4 = very satisfied)