By completing this survey, you give Pulpdent Corporation permission to use the information you provide below for quality assurance and compliance purposes.

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* 1) How often do you use dental adhesive?

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* 2) Which bonding material do you use regularly? (Please select only one for this survey)

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* 3) How long have you been using this material?

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* 4) What do you like most about this product?

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* 5) Please rate the characteristics of the material you chose

  Excellent Good Fair Poor N/A
Marginal Integrity
Flowability
Handling
Setting Time
Color Match
Bonding
Durability
Strength

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* 6) For any answer of fair or poor, please explain:

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* 7) Have your patients experienced any negative issues such as allergic reaction, post-op sensitivity, or infection after use of this material?

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* If yes, please rate the severity of the issue

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* 8) How often have you had to replace or repair a restoration done with this material?

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* 9) If you have had to replace restorations done with this material, how many were replaced within;

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* 10) What are the main reasons you have had to replace or repair restorations done with this material?

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* Comments: 

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* Are you a dental healthcare provider?

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* I give Pulpdent consent to follow up in 6 months

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* We ask that you provide your contact information so we may reach you if needed to ensure the safety of our products. Information will not be used for marketing e-mails or phone calls, apart from notifying eligibility parties for gift card giveaways.

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* Internal Use Only

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