Full Name

Mobile

Email

Country

Title

Address (Road Name, Street Number, Postcode, City):

1.Country, title, name, address, and contact information

2. What type of clinic/distributor do you have / represent? 2. What type of clinic/distributor do you have / represent? a. Dermatology b. Plastic Surgent c. Surgical Ward d. Beauty Clinic e. Other

3. What dermatological issues is/are in focus for the demonstration you require? 3. What dermatological issues is/are in focus for the demonstration you require? a. Skin rejuvenation (ablative) b. Skin disorders (dermatology surgery) c. Skin pigments d. Hair removal e. Vascular – diffuse redness f. Vascular – prominent / clear veins g. Vascular – leg veins h. Varicose saphenous veins (cannot demo, but love to discuss) i. Body sculpturing & contouring (cannot demo, but love to discuss) j. Hyperhidrosis (sweat) (cannot demo, but love to discuss) k. Nail fungus l. Other

4. What product priorities do you have? 4. What product priorities do you have? a. Best wavelength or product for a very specific treatment b. Best combination product for my needs, as I want to limit my investments c. Best initial price d. Best long-term costs – best return on investment

5. What lasers do you use today?

6. Do you have a clear opinion on what product suits your needs best? If so, please indicate the one 6. Do you have a clear opinion on what product suits your needs best? If so, please indicate the one a. MedArt SmartSculptTM b. MedArt FRx CO2 Laser c. MedArt FRx Intenz CO2 d. MedArt VariMedTM 810nm Diode Laser System e. MedArt ILVO™ 1470nm Diode Laser f. MedArt NeoNailTM

7. What trends do you see within aesthetic, surgical and/or medical lasers?

8. Other information we should know? (open question / notes)

9. Your Email