1.Address

Veterinarian Name

Clinic Name

Address

Address 2

City/Town

State/Province

AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

ZIP/Postal Code

Country

Email Address

Phone Number

2.How did you hear about Cool Renewal?

Online Search

Advertisment

Distributor Catalog- Online or Print

Distributor Representative

Tradeshow/ Meeting

Another Cool Renewal Customer

Other (please specify)

3.How Satisfied are you with the performance of Cool Renewal?

Very Satisfied

Satisfied

Disappointed

4.What do you think about the price?

Very Affordable

Affordable

Too Expensive

5.Which Applicators do you prefer to use?

Foam Tipped Applicators

Plastic Isolation Funnels

Skin Tag Tweezers

6.Which types of skin lesions do  you typically treat?

Warts/ Papillomas

Skin Tags

Distichiasis / Trichiasis / Eyelid Tumors

Sebaceous Adenomas

Sarcoids

Other (please specify)

7.How much do you typically charge patients for treatments with Cool Renewal?

$40-$60

$60-$80

$80-$100

Other (please specify)

8.Who is your preferred Veterinary Supply Distributor?

9.Do you have any suggestions for improving our product?

Suggestion 1

Suggestion 2

Suggestion 3

10.Nothing speaks louder than personal experience. Please provide a brief testimonial about your experience with Cool Renewal!