eakin dot® 1 piece Drainable Pouches. Now available to sample for free.

Eakin Freeseal Evaluation Form

Date evaluation completed
Patient
Product

Stoma
Pouch(es) prescribed
Skin
Peristomal plane

What were your reasons for prescribing eakin freeseal?
Please select all that are relevant.
What benefits did your patient experience with freeseal?
Please select all that are relevant.
Would you recommend incorporating eakin freeseal into the patients routine to help prevent leaks and MASD?
Did having multiple starter hole sizes give you versatility to find the best fit?
Did you experience a clean removal?
Did the seal remove in one piece?

Yes – why and how effective was it? No – please provide comments

Would you like to help others learn from your experience by being part of a case study?
Can we use your answers and/or comments anonymously in any marketing material and keep your data on file?
If you ticked “Yes” above, then please note: Your name will be held by Omnigon Care Solutions, at the registered Suite 2 Level 2/582 Swan St, Burnley VIC 3121. Your comments may be used anonymously* in marketing literature, both printed and online, and to support our applications to have this product listed on various national reimbursement schemes. *For example: Mr J S, England. Your details will never be passed to third parties without your express consent. A full copy of our Privacy Policy is available on request from the above address and on our website.