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CLINICAL EVALUATION FORM MAIL TO Sage Products attn Customer Service 3909 Three Oaks Road Cary IL 60013 Product 7524 Comfort Shield with Dimethicone Facility Sales Rep STRONGLY DISAGREE AGREE N/A I recognize the importance of cleansing and barrier application in maintaining skin integrity and Comfort Shield helps me better facilitate this process. O Comfort Shield makes it easier to follow my unit s incontinence skin care protocol* our current soap/cleanser barrier cream s and other products. skin* on my patient s skin* I understand the importance of perineal skin assessment and method. to focus on other patient care activities. Please completely fill in the appropriate response circle for all questions. With Comfort Shield I decreased the amount of linens washcloths towels cleansers moisturizers and barriers used vs. previous methods of incontinence care. Staff Name sage10364D Additional comments www. sageproducts. O Comfort Shield makes it easier to follow my unit s incontinence skin care protocol* our current soap/cleanser barrier cream s and other products. skin* on my patient s skin* I understand the importance of perineal skin assessment and method. to focus on other patient care activities. skin* on my patient s skin* I understand the importance of perineal skin assessment and method. to focus on other patient care activities. Please completely fill in the appropriate response circle for all questions. With Comfort Shield I decreased the amount of linens washcloths towels cleansers moisturizers and barriers used vs. Please completely fill in the appropriate response circle for all questions. With Comfort Shield I decreased the amount of linens washcloths towels cleansers moisturizers and barriers used vs. previous methods of incontinence care. Staff Name sage10364D Additional comments www. sageproducts. O Comfort Shield makes it easier to follow my unit s incontinence skin care protocol* our current soap/cleanser barrier cream s and other products. skin* on my patient s skin* I understand the importance of perineal skin assessment and method. to focus on other patient care activities. Please completely fill in the appropriate response circle for all questions. With Comfort Shield I decreased the amount of linens washcloths towels cleansers moisturizers and barriers used vs. skin* on my patient s skin* I understand the importance of perineal skin assessment and method. to focus on other patient care activities. Please completely fill in the appropriate response circle for all questions. With Comfort Shield I decreased the amount of linens washcloths towels cleansers moisturizers and barriers used vs. previous methods of incontinence care. Staff Name sage10364D Additional comments www. sageproducts. .

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