Customer Survey

Name: *

Customer Number (If Known):

Dental Practice Name:

Telephone: *

Fax Number:

Email: *

Specialty:

Which Implant Direct products are you currently using (Select All That Apply)

ScrewPlant Family	ScrewPlus Family	ScrewDirect Family
ScrewIndirect Family	ScrewRedirect Family	Legacy Family
RePlus Family	RePlant Family	Implants Only (Select Family)
Prosthetics Only (Select Family)	Surgical Instruments/Tools	No purchases yet

What is your Primary implant/prosthetic system?

Please rate the following statements regarding our overall level of performance:

	Disagree		Neutral	Agree		N/A
	1	2	3	4	5	N/A
Implant Direct has a broad line of Dental Implant Products
Implant Direct's web site is intuitive and easy to navigate
Implant Direct's cost effective approach to implant dentistry is the reason I started using the product line.
It has been easy to incorporate Implant Direct's Application specific products into my Nobel based practice
It has been easy to incorporate Implant Direct's Application specific products into my Zimmer based practice
I find Implant Direct's prosthetics easy to understand and use
My Implant Direct contact is knowledgeable and offers solutions to accomplish my goals
I would recommend Implant Direct to my colleagues

What percentage of the implants placed in your practice are from Implant Direct?

Which of the following has had a positive impact on your decision to work with Implant Direct? (Check all that apply)

Website	Marketing Material/Mailing	Journal/Magazine Advertisement	Trade Show Booth / Representatives
Meeting / Presentation with Implant Direct Representative(s)	Calls from Technical Sales Department	Attended an Implant Direct lecture	Referral from a colleague:

Are there any additional products that you would like Implant Direct to provide?

Please tell us if there is anything that we could be doing to improve our overall service.

* You cannot leave these fields blank!