Thank you for your commitment to continuous improvement by completing this Product Feedback Form and providing Hologic with important information regarding your Suros or MammoPad product. We appreciate your desire for continued product quality. Whenever possible, retain the product in question and return it in the Hologic-provided biohazard container for an internal investigation, analysis and resolution. Customers returning products in question will receive a 100% product return credit.


Please provide the information requested below in submitting your product feedback. Areas indicated with an asterisk (*) are required data entry fields and must be completed to submit this Product Feedback Form.


CUSTOMER Contact Name
*First Name
*Last Name
CUSTOMER Contact Phone & Email
*Phone Number
*Email Address
I prefer to be contaced by (choose one):
  Email      
 Phone
Account Information
*Account Number
*Account Name
Account Address
Suite Number or Department Name
City
*State
Zip Code
Name of your Hologic Sales Representative
Name of your Hologic Clinical Education Specialist
Ship To
Please provide accurate shipping information below for product delivery.

First Name
Last Name
Suite Number or Department Name
City
*State
Zip Code
Product Feedback
What is the product feedback in regards to?
 Console or Adapter
 Disposable product (i.e. handpiece, marker, etc.)
 Ancillary items (i.e. needle guides, tissue filter, cannisters, etc.)
 MammoPad
 Cause not clear -- may be console or handpiece
Please provide a detailed description of the issue experienced.
Product Label Information
*Select a product family
*Device part number
Device or product name
*Lot or serial number
Quantity of product possibly defective
Was a MedWatch form submitted for this issue? What is MedWatch?
 yes
 no
 unkown at this time
*Is the device in question available for return for investigation and analysis?
 yes
 no
Do you wish to be contacted with the results of the product analysis?
 yes, via email
 yes, via phone
 no, thank you