J. Morita USA - CaineTip Survey




•	Consumables

•	Small Equipment

•	Heavy Equipment

CaineTips Survey

FREE CaineTips

Please take a moment to complete the following short survey (U.S. Dentists/Hygienists ONLY). This will help us to better understand the needs and desires of our valued customers. Once the completed survey is submitted we will send you a free sample of CaineTips. Designed for intraoral applications, CaineTips offer easy to use, topical pain relief. Each swab is pre-filled with a 20% Benzocaine solution. CaineTips are ideal for temporary pain relief during dental and hygiene procedures.

*Doctor's Name you work for:

*Attn. & Title:

*Practice Address 1:

Practice Address 2:

*City:

*State:

*Zip Code:

*Practice Phone:

Fax:

*Doctor's License #:

*Email:

(Your address will not be shared with other companies.)

Year of Graduation:

*Your Specialty:

*Name of topical anesthetic you're currently your using:


*What you like about your current topical anesthetic:


*What you don't like about your current topical anesthetic:


*How much does your current topical anesthetic cost with the swabs:

*Required fields