contact form · medibottle customer evaluation form · privacy policy · return policy

medibottle Evaluation Form

The experience you and your baby have is important to us and your feedback can help create awareness of the product. Please let us know what you think!

What is your name?
What is your e-mail address?
What is your city and state?
How old is your baby?
What medicine(s) were given?
What was the size of the dose(s)?
How difficult was it to give your baby medication before using medibottle?	Not difficult Somewhat difficult Difficult Very Difficult
How much of the prescribed dose do you estimate your baby would take before using medibottle?	Less then 1/4 (25%) Less than 1/2 (50%) Less than 3/4 (75%) Less than 100% 100%
Did you find the instructions (especially the explanation of "little squirt") acceptable?	Yes No
How long did it take to give the medicine?	About 1 min. 1-2 min. More than 2 min.
How difficult was it to give your baby medication using medibottle?	Not difficult Somewhat difficult Difficult Very difficult
How much of the prescribed dose did your baby receive when using medibottle?	Less then 1/4 (25%) Less than 1/2 (50%) Less than 3/4 (75%) Less than 100% 100%
Would you recommend the medibottle to others?	Yes No
How did you hear about the medibottle?	Nurse Pharmacist Physician Child Birth Educator Hospital Other
We welcome any comments you may have!