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AQIB TRADING COMPANY (PVT.) LTD.

Surgical & Medical Disposables • Islamabad, Pakistan • www.atcpvtl.com

END-USER PRODUCT EVALUATION & FEEDBACK FORM

For Hospital / Healthcare Professional Evaluation

Document No.ATC/QA/FRM-01/WEB-0144/2026

Revision001

Effective Date15 Sep 2026

✓ Please complete all required fields. Select the option that best reflects your actual product-use experience. Your feedback helps ATC monitor product quality and user satisfaction.

1Product & Evaluation Details

Hospital / Institution *

Department / Unit *

Product Name *

Brand / Model (optional)

Batch / Lot No. (optional)

Date of Use (optional)

Quantity Evaluated (optional)

PO / Reference No. (optional)

ATC Representative (optional)

Evaluation Date *

2End-User Information

Name of End-User *

Designation *

Department / Specialty (optional)

Years of Experience (optional)

Contact (optional)

Email (Optional) (optional)

3Product Performance Evaluation

Please rate each criterion based on your actual experience with the product.

Evaluation Criteria	Excellent	Good	Satisfactory	Unsatisfactory	N/A	Comments / Observations
Overall Product Quality *	Excellent	Good	Satisfactory	Unsatisfactory	N/A
Ease of Use / Handling	Excellent	Good	Satisfactory	Unsatisfactory	N/A
Clinical / Technical Performance	Excellent	Good	Satisfactory	Unsatisfactory	N/A
Reliability / Consistency	Excellent	Good	Satisfactory	Unsatisfactory	N/A
Patient / User Comfort	Excellent	Good	Satisfactory	Unsatisfactory	N/A
Packaging & Presentation	Excellent	Good	Satisfactory	Unsatisfactory	N/A
Instructions / Labelling	Excellent	Good	Satisfactory	Unsatisfactory	N/A
Overall Satisfaction *	Excellent	Good	Satisfactory	Unsatisfactory	N/A

4Clinical / User Experience

Was the product easy to use as intended? *

YesNoWith difficulty

Did the product perform as expected during use? *

YesNoPartially

Were any defects, failures, adverse observations or complaints noted? *

NoYes — describe below

Would you recommend continued use of this product? *

YesWith observationsNo

Details of Any Complaint / Defect / Observation

5Comparison & Recommendation

Compared with previously used brand / product

BetterSimilarLess satisfactoryN/A

Key advantage(s) observed

Additional comments / recommendations

6End-User Confirmation

End-User Signature * Your name will be used as a digital signature below the signature field where applicable.

Date *

Hospital / Department Stamp (optional)

Upload a clear stamp image

JPG, PNG or WebP • Maximum 5 MB

ATC Representative Signature

I confirm that the above feedback is based on actual use and evaluation of the stated product, and represents my professional observation at the time of evaluation.

For ATC Office Use Only

Received By (optional)

Date Received (optional)

Acknowledgement / Reference No. (optional)

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