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Silagen "What the Experts Say" Data Collection
We're building a brand new Silagen website and would love to include your experience with Silagen!
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1.
On which Silagen products would you like to share your experience?
(Required.)
Silagen Silicone Scar Gels
Silagen Silicone Sheeting, Strips and Shapes
Entire Silagen Scar Refinement System (both gel and sheeting)
Silagen Day/Night Silicone Gel Twin Pack (one bottle of Silagen + SPF 30 for Day, Silagen Pure Silicone for night)
Silagen Arnica-Bromelain Complex Oral Supplement
Silagen Topical Recovery Gel with Arnica and Vitamin K
Silagen Rapid Recovery Kit including one bottle of Arnica-Bromelain Complex Supplement and one tube of Recovery Gel
Entire line, including scar products and bruise/recovery products
Other (please specify)
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2.
Tell us about your experience with Silagen products selected in question 1. Content can include what products you use, what type of procedures you use them for, results you have seen, what your patients tell you, or even what you like about packaging, sales rep, general experience with brand.
(Required.)
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3.
May we quote you in the "What the Experts Say" section of the under construction new Silagen website?
(Required.)
Yes
No
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4.
Tell us about you and your practice
(Required.)
Name of Physician/Practitioner with appropriate suffix, i.e. MD, DO PA-C CNP etc.
Practice Name
Specialty
Practice Street Address
Practice City
Practice State
Practice Zip Code
Practice Phone Number
Practice website
Contact name (in the event we have any questions)
Contact email and/or phone number
5.
Please upload a headshot or other preferred photo that we can use with your comments. We will provide a link to your website so potential patients may contact you.
If you have any questions or have an issue completing the survey please contact Lisa Massaad-- email: lisa@newmedical.com phone: 440-212-0998
Thank you for sharing!
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