Richmond Dental

home | about | faq | contact | news

FoamEZ™ Mirror Wipe Survey

We value your opinion! Please take a few moments to fill out this short survey.



Name: *
Title:
Practice Name: *
Address: *
City, State, Zip: *	,
Email: *

*Please mark all that apply

It is our policy to respect your privacy regarding any information we may collect while conducting our business online or in person. We will not sell or rent this information to anyone.

1. How do you rate the performance of the FoamEZ™ Mirror Wipe?

Excellent
Good
Fair
Poor

2. Did the FoamEZ™ Mirror Wipe slide easily onto the syringe tip??

Yes
No

If "No", please explain:

3. Did the FoamEZ™ Mirror Wipe secure on the syringe tip?

Yes
No

If "No", please explain:

4. Did the FoamEZ™ Mirror Wipe become saturated with use?

Yes
No

If "No", please explain:

5. Did you find the FoamEZ™ Mirror Wipe effective in removing fog and or debris?

Yes
No

If "No", please explain:

6. Would you purchase the FoamEZ™ Mirror Wipe?

Yes
No

If "No", please explain:

Type the characters you see in the picture

home \| about \| faq \| contact \| news \| terms \| credit app
site by WEBPRO	© 2011 Richmond Dental. All Rights Reserved.