Clinical Evaluation Form

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Clinical Evaluation Form

To create your custom Clinical Evaluation Form, start by entering the following information:

Your Name:		Click here to print the full list of questions. Click here to print a sample of a finished form.
Facility Name:
Unit:
Return Form To:

Next, check the boxes next to the questions you would like to have printed on the form. A maximum of 10 questions can be selected. When finished, click "Next Step."

Prevalon effectively relieves heel pressure.

Prevalon effectively floats the heel for total pressure relief.

Prevalon elevates and separates the heel from the mattress surface.

Prevalon effectively prevents foot drop.

Prevalon's foot drop prevention capabilities are an improvement over our current methods.

Prevalon helps protect my patient's foot, heel and ankle from pressure, friction and shear.

Prevalon stays on the foot and helps keep it properly positioned.

Prevalon effectively reduces foot rotation within the device.

Prevalon's comfort-grip interior effectively reduces foot rotation within the device.

Prevalon's comfort-grip interior helps minimize potential for friction and shear.

Prevalon's interior is comfortable for my patients.

Prevalon has no hard, sharp or rough edges that could damage my patients skin.

Prevalon's stretchable panels help provide a secure yet comfortable fit.

Prevalon's low-friction outer surfaces help maintain patients' freedom of movement over bed linens.

Prevalon's open heel design makes it easier to monitor skin condition between assessments.

My patient's foot does not get uncomfortably warm while wearing Prevalon.

Prevalon's pontoon bottom helps stabilize the foot in an upright position.

Prevalon is compatible with deep vein thrombosis (DVT) compression devices.

Prevalon's stretchable closure easily accommodates deep vein thrombosis (DVT) compression device tubing.

Prevalon adjusts easily to fit all or most of my patients.

Prevalon is easy to put on my patient's foot.

Prevalon saves time and enables me to focus on additional patient care activities.

I believe Prevalon Pressure-Relieving Heel Protector is an important improvement in the quality of patient care at this facility.

My patients prefer Prevalon over previous devices used for pressure reduction/relief.

Prevalon represents an improvement over previous devices used for pressure reduction/relief at this facility.

I recommend using Prevalon Pressure-Relieving Heel Protector at this facility.

I recommend using Prevalon Pressure-Relieving Heel Protector over pillows for pressure reduction/relief.

I recommend using Prevalon Pressure-Relieving Heel Protector over previous devices for heel pressure reduction/relief.

I recommend using Prevalon Pressure-Relieving Heel Protector over previous methods of heel pressure reduction/relief.

I recognize the importance of relieving heel pressure for patients at risk for developing pressure ulcers, and Prevalon helps me better facilitate this process.

Prevalon makes it easier to follow my unit's heel care protocol.

Prevalon's pressure-relieving capabilities are an improvement over our current methods.

Prevalon petite provides the ideal fit and performance for smaller (size 7 womans, size 6 mens)

The Prevalon Foot and Leg Stabilizer Wedge provides additional protection against lateral foot and leg rotation.

The Prevalon Foot and Leg Stabilizer Wedge helps reduce pressure on the lateral side of the leg.

The Prevalon Foot and Leg Stabilizer Wedge easily attaches to Prevalon Heel Protector.

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