Outcomes Monitoring: 30 Day Survey - VOLARA System

Fill out the form below and a member of the Baxter Respiratory Health team will be in contact with you.

Patient Name*

Patient Phone Number*

Volara System serial number is located on the back of the control unit.

Serial Number (seven digit number)

Are you able to complete your therapy sessions as prescribed? If no, why not?*

If Other, please explain.

How would you evaluate the overall therapy in meeting your needs?*

How would you evaluate the comfort of the therapy/device (relative to your expectations)?*

What is the likelihood you would recommend the therapy to others?*

Please explain your reasoning

We’d love to hear from you on your overall experience with this therapy. If willing, please share how this therapy has impacted you positively/negatively in your day-to-day life.

Do you need to order replacement supplies?*

If Yes, explain reason why replacement is needed.

*required

Respiratory Health

Advancing respiratory health through innovative therapies

Hill-Rom® Respiratory Care