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* 1. Email Address

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* 2. Please select the age range that applies to you

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* 3. Gender

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* 5. How did you find out about Bloccs?

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* 6. Who did you buy a Bloccs waterproof protector for?

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* 7. If bought for child how old are they?

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* 8. Which product(s) were used?

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* 9. What will the cover be used for?

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* 10. Which hospital, clinic or health centre is currently doing the treatment?

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* 11. Did the hospital, clinic or health centre provide you with information about Bloccs?

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* 12. If you are in the UK, did you know our covers were available on prescription? (applies to people in the UK only)

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* 13. Would you recommend Bloccs to a friend?

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* 14. Would you like us to keep in touch via the email you have supplied?

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* 15. Can we use the results of this survey for marketing purposes?

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