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* 1. What is your Name and Surname?

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* 2. Which Renewal Institute branch do you visit most often?

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* 3. If you would like us to update your e-mail address on our client database, please fill in your current e-mail address below?

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* 4. Please select your gender?

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* 5. Please select your age group:

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* 6. Have you had any botulinum toxin (Botox or Dysport), or dermal filler treatments done?

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* 7. In which of the below areas have you had botulinum toxin done:

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* 8. If you had treatments with a botulinum toxin, did it work by reducing the appearance of wrinkles?

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* 9. If you have a botulinum toxin treatment, how long did the effects last?

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* 10. In which of the below areas have you had dermal filler treatment?

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* 11. If you had dermal filler treatments, did it work by improving the area of concern?

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* 12. If you had dermal filler treatment, how long did the effects last?

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* 13. At which age did you have your first botulinum toxin or dermal filler treatment?

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* 14. What is botulinum toxin made of:

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* 15. What elements should you consider to ensure your injectable treatments are safe: 

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* 16. When receiving filler, which are the areas one must take caution with, and ensure one has an experienced injector:

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* 17. Would you like a Renewal Institute staff member to contact you to discuss the survey?

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