Clinical Outcomes Information for Potential Publication

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Sage is committed to helping you present your clinical success story to your peers. Please complete this form and a representative from Sage will contact you to discuss how we can best help you. View success story examples
Clinician Name:
Title:
Hospital Name:
Location:
LIN Affiliation:
Phone:
Email:
Product/Process Change:	Antiseptic Body Cleanser Sacral Protection Heel Protection Incontinence Care Oral Care Skin Care
Brief description of success story:
How long has the Sage product been in use?

Do you have at least six months of quantifiable data related to product usage?	Yes No

Will you need approval from administration to participate in Sage's case study program?	Yes No

Are you planning to pursue publishing this same success story in a clinical journal?	Yes No


Other Information:

Sage Rep. Name:

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