Questionnaire

All information entered is confidential. We will only use it to improve our ability to deliver cutting-edge simulators to the medical community.

Gender
Male	Female
Location (City and State or City and Country)
Age Range
Under 30	50 - 59
30 - 39	60 - 65
40 - 49	Over 65
Position
Physician Program Director	Residency Program Coordinator
Other
Department
General Surgery	Anesthesiology
Urology	Obstetrics and Gynecology
Orthopaedics	Pain Medicine
Other
How did you hear about Verefi Technologies?
Publications	School/Institution
Internet	Business Alliance
Trade Show	Email
Other
What do you see as an appropriate proportion of simulator use in your curriculum?
Small
Medium
Large
Do you have a curriculum that uses simulators? If so, which ones do you use?
If you could have one simulator designed and developed, what would it be?
What are the essential functions that you would like to see included in the simulator? (Check all that apply.)
Haptics	Virtual Surgical Procedures
Virtual Reality	Real Anatomy
Scores	Full/Partial Task Trainer
Other
How much would you be willing to pay for such a simulator (in US dollars)?
Less than 10,000	30,000 - 39,999
10,000 - 19,999	40,000 - 49,999
20,000 - 29,999	50,000 or more
Additional Comments and Suggestions