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 personally use Etch products?(Required.)

0-5 times per day

6-10 times per day

More than 10 times per day

*2) Which etch material do you use regularly? (Please select only one for this survey)(Required.)

Etch-All 10% Phosphoric Acid Etching Gel

Etch-Rite 38% Phosphoric Acid Etching Gel

Etch-Royale 37% Phosphoric Acid Etching Gel

Semi-Gel Etchant 35% Phosphoric Acid Etching

Porcelain Etch Gel

Dentin Conditioning Gel

Other (please specify)

*3) How long have you been using this material?(Required.)

0-1 year

1-3 years

More than 3 years

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

Flowability

Excellent

Good

Fair

Poor

N/A

Handling

Excellent

Good

Fair

Poor

N/A

washability

Excellent

Good

Fair

Poor

N/A

*6)  For any answer of fair or poor, please explain:(Required.)

*7) Have your patients experienced any negative issues such as allergic reaction, post-op sensitivity, or infection after use of this material?(Required.)

No

Yes (please specify)

*If yes, please rate the severity of the issue(Required.)

Temporary mild

Temporary moderate

Temporary severe 

Required medical attention

Comments: 

*Are you a dental healthcare provider?(Required.)

Yes

No

*I give Pulpdent consent to follow up in 6 months(Required.)

Agree

Disagree

*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.(Required.)

Name

Company

Email Address

Phone Number

Internal use only