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FILLERS
Let us asked couple of more questions about your fillers knowledge and needs
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1.
what is you gender
(Required.)
Male
Female
Rather no to answer
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2.
Have you had fillers before?
(Required.)
Yes, less than six months ago
Yes, More than six months ago
No
3.
If yes, what did you get the fillers for?
Lip augmentagion
Cheek Augmentation
Under the eye and tear trough area
creases and deep lines in the forehead
Chin or nose
Other (please specify)
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4.
Do you know what brand was used
(Required.)
Juvederm from Allergan
Restylane from Gladerma
Note sure about the brand
Other (please specify)
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5.
Did you know which injection technique were used?
(Required.)
Sharp needles with multiple injection sites
Blunt cannula with very few injection sites
Both
Not sure
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6.
have you had to go back to the provider for any correction?
(Required.)
Yes
No
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7.
Overall, how satisfied or dissatisfied are you with with the results?
(Required.)
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
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8.
How do you choose your cosmetic clinic and provider?
(Required.)
Google reviews
Facebook reviews
Number of Instagram followers
The clinic's location
Prices and discounts available
Other (please specify)
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9.
How did you hear about us?
(Required.)
Google search
Facebook ad
Instagram ad
Printed media
Word of mouth
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10.
Please fill in your contact information so we can answer your questions
(Required.)
First name
*
Last name
Email Address
*
Phone Number
*
*
11.
How do you like us to contact you?
(Required.)
Phone call
Email
Text message
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