By completing this survey, you give Pulpdent Corporation permission to use the information you provide below for quality assurance and compliance purposes.

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

KOOL-DAM

Porcelain Etch Gel

Dentin Desensitizer

Dry-Rite

SNOOP Caries Disclosing Agent

Flecta Disposable Mirror

Sparkle Porcelain Polishing Paste

Other (please specify)

2) How often do you use this material?

0-5 times per week

6-10 times per week

More than 10 times per week

*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

Setting Time

Excellent

Good

Fair

Poor

N/A

Color Match

Excellent

Good

Fair

Poor

N/A

Durability

Excellent

Good

Fair

Poor

N/A

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.)

No

Yes, please specify

If yes, please rate the severity of the issue

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.

Name

Company

Email Address

Phone Number

Internal use only