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Reflective Shields Plus 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.

Please rate the following?

1. Comfort

Excellent Good Fair Poor

2. Absorbency

Excellent Good Fair Poor

3. Ability to retract

Excellent Good Fair Poor

4. Reflective property/Illumination

Excellent Good Fair Poor

5. Size small

Excellent Good Fair Poor

6. Size large

Excellent Good Fair Poor

Additional comments:

7. Check the product you currently use in your practice:

Cotton Roll
Dry Angles
Dry Tips
Neo Drys
Dry Aids

Other:

8. How do you compare the performance of the Reflective Shield Plus to the above:

Better
About the same
Not as good

Comments:

9. For what applications did you use this product?

10. Would you purchase this product?

Yes
No
Maybe

Comments::

Type the characters you see in the picture

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