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Bonding Agents

By completing this survey, you give Pulpdent Corporation permission to use the information you provide below for quality assurance and compliance purposes.
1) How often do you use dental adhesive?
2) Which bonding material do you use regularly? (Please select only one for this survey)(Required.)
3) How long have you been using this material?(Required.)
4) What do you like most about this product?
5) Please rate the characteristics of the material you chose(Required.)
Excellent
Good
Fair
Poor
N/A
Marginal Integrity
Flowability
Handling
Setting Time
Color Match
Bonding
Durability
Strength
6) For any answer of fair or poor, please explain:
7) Have your patients experienced any negative issues such as allergic reaction, post-op sensitivity, or infection after use of this material?(Required.)
If yes, please rate the severity of the issue
8) How often have you had to replace or repair a restoration done with this material?
9) If you have had to replace restorations done with this material, how many were replaced within;
10) What are the main reasons you have had to replace or repair restorations done with this material?
Comments: 
Are you a dental healthcare provider?(Required.)
I give Pulpdent consent to follow up in 6 months(Required.)
We ask that you provide your contact information so we may reach you if needed to ensure the safety of our products. Information will not be used for marketing e-mails or phone calls, apart from notifying eligibility parties for gift card giveaways.
Internal Use Only