Doctor Name*
 
 
Office Phone Number*
 
 
Email*
 
 
 
How many doctors are in your practice?*
 
1
2
3
4
5
5-10
10-15
15+
 
 
 
 
What days is your office open? Select all that apply.*
 
Monday
Tuesday
Wednesday
Thursday
Friday
 
 
 
 
Do you work at or own any other offices?*
 
No
Yes. List other office(s) address and phone number:
 
 
Rate your satisfaction of Garrison® as a business regarding customer service/sales staff.*
 
Very satisfactory
Somewhat satisfactory
Neutral
Somewhat unsatisfactory
Very unsatisfactory
 
 
Rate your satisfaction of Garrison® as a business regarding product knowledge.*
 
Very satisfactory
Somewhat satisfactory
Neutral
Somewhat unsatisfactory
Very unsatisfactory
 
 
Rate your satisfaction of Garrison® as a business regarding clinical knowledge.*
 
Very satisfactory
Somewhat satisfactory
Neutral
Somewhat unsatisfactory
Very unsatisfactory
 
 
Rate your satisfaction of Garrison® as a business regarding product value.*
 
Very satisfactory
Somewhat satisfactory
Neutral
Somewhat unsatisfactory
Very unsatisfactory
 
 
Rate your satisfaction of Garrison® as a business regarding shipping of the product.*
 
Very satisfactory
Somewhat satisfactory
Neutral
Somewhat unsatisfactory
Very unsatisfactory
 
 
Rate your satisfaction of Garrison® as a business regarding meeting the customers' needs.*
 
Very satisfactory
Somewhat satisfactory
Neutral
Somewhat unsatisfactory
Very satisfactory
 
 
What would you like to see in our email communications? Select all that apply.*
 
More frequent special offers
More enticing offers (bigger discounts, buy one get one, etc.)
Detailed clinical information
Product tips and tricks
Nothing - please don't email me
 
 
Other email communication requests:
 
 
 
Is there a product that you "wish someone would invent?" If yes, explain.*
 
 
 
Do you exclusively use Garrison® Wedges?*
 
Yes
If no, what brand do you use and why?
 
 
Do you exclusively use Garrison® Matrix Bands?*
 
Yes
If no, what brand do you use and why?
 
 
Do you exclusively use Garrison® Separator Rings?*
 
Yes
If no, what brand do you use and why?
 
 
What improvements/changes would you like to see in the Garrison® products you use? Please list product and improvement(s)/change(s).*
 
 
 
Have you seen or heard about our new Rally™ Mini Polishers for Composite?*
 
Yes
No
 
 
 
 
Have you seen or heard about our new FitStrip™ Flexible Interproximal Finishers?*
 
Yes
No
 
 
 
 
Who makes the buying decisions in your office? Select all that apply.*
 
Doctor
Assistant
Office Manager
Office Staff
Hygienist
Other
 
 
 
 
Who does the purchasing in your office? Select all that apply.*
 
Doctor
Assistant
Office Manager
Office Staff
Hygienist
Other
 
 
 
 
Would you prefer a $10 Starbucks gift card or a $20 Garrison® discount? (Discount must be used on or before 7/31/2017).*
 
$10 Starbucks gift card
$20 Garrison® discount