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* 1. Have you had Lip fillers before?

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* 2. If you had lip fillers before, were you satisfied with the results?

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* 3. How do you choose your cosmetic clinic and provider?

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* 4. Are you planning to do the injection in the coming two weeks?

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* 5. How did you hear about us?

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* 6. Which one of these celebrities has your dream lips?

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* 7. Do you prefer a specific brand of fillers?

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* 8. Please fill in your contact information to receive the $100 discount coupon

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* 9. How would you like us to contact you?

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* 10. Please choose today's date

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