J. Morita USA - Survey




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•	Survey

Survey

Please take a moment to complete the following short survey (U.S. Dentists ONLY). This will help us to better understand the needs and desires of our valued customers.

*Name:

*Address 1:

Address 2:

*City:

*State:

*Zip Code:

*Phone:

Fax:

*License #:

*Email:

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

Year of Graduation:

*Type of Practice:

*Dental Journals most frequently read:(multiple selections allowed)

	ADA News			Dental Town
	Compendium			Dentistry Today
	Contemporary Esthetics			Dental Products Report
	Dental Equipment & Materials			Endodontic Therapy
	Dental Practice Report			Journal of Endodontics
	Dental Economics			PPAD

*Your dental product purchasing decisions are based on:(list in order - 1 being best)

	Price
	Ease of Use
	New Technology
	Time Savings
	Patient Satisfaction

*Your dental product purchasing decisions are in response to:(list in order - 1 being best)

	Print/Journal Ad
	Internet
	Trade Shows
	E-Mail
	Lectures/Study Clubs
	Independent Research Publications

*Independent Research Publication Subscriptions:(multiple selections allowed)

	CRA Newsletter
	Dental Advisor
	Reality
	None

Other:

*Product of Interest:(multiple selections allowed)

	Adhesives
	Cheek & Lip Retractor (Free Access II)
	Chairs (Spaceline EMCIA, Feel 21)
	Crown & Bridge Remover (ATD C&B Remover)
	Endo Equipment (Root ZX II, Tri Auto ZX, Rotary Master)
	Impression Materials (Perfectim Systems)
	Restoratives (CB Temp, FormCore DC)
	X-Ray (Veraviewepocs Pan/Ceph, Veraview IC5)
	Posts (CF Carbon Fiber Post, GF Glass Fiber Post)
	Tomography (3D Accuitomo FPD)

Other:

*Do you receive J. Morita's "News & Views" Newsletter?	Yes	No
*If yes, Would you prefer to receive it via email?	Yes	No
*If no, indicate your preference here to be added to the "News & Views" mailing list.	Email	Mail

*Required fields