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Dental Company

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- Step 1 of 4

Name *

Occupation

Email *

Phone *

Address Line 1

Address Line 2

City *

State / Province / Region *

Postal Code

Country

Submitted by

Please rate your experience with DMG products and services (1 = Very Dissatisfied and 5 = Very Satisfied): *

5
4
3
2
1

How likely are you to continue to purchase DMG products in the future? (1 = Very Unlikely and 5 = Very Likely) *

5
4
3
2
1

How would you rate your experience with our Customer Service Department? (1 = Very Dissatisfied and 5 = Very Satisfied) *

5
4
3
2
1

How responsive is our Customer Service Department with your questions or concerns? (1 = Very Unresponsive and 5 = Very Responsive) *

5
4
3
2
1

How did you hear about our survey?

Sales Professional
Customer Service Department
www.DMG-America.com
I received an email from DMG
Free goods package
www.DMG-Connect.com

We encourage you to share with us any additional comments, questions, or concerns about our organization, products or services.

(1 Icon and

Please rate your satisfaction with the DMG products and services below. 1 = Very Dissatisfied and 5 = Very Satisfied

Luxatemp Ultra

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Luxatemp Plus

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Luxatemp Fluorescence

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Icon

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaCrown

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Honigum

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

StatusBlue

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

TempoCemID

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Kolorz ClearShield

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaFlow Ultra

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaFlow

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaBite

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

O-Bite

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaGlaze

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaCore Z Dual

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Ecosite Elements

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Ecosite One

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Ecosite Bulk Fill

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Ecosite Bond

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaPost

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

PermaCem 2.0

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Ionosit Baseliner

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaBond

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Kolorz Prophy Paste

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Kolorz Foam

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Kolorz Gel

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Kolorz Topical Anesthetic

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

DentaMile connect (Splint and Bleach Tray Workflows)

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Digital Hardware (3Demax, 3Dewash, 3Decure, DentaMile Lab 5 Pro, DentaMile Desk MC-5, Dentamile Wash MC, DentaMile Cure MC)

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

LuxaPrint (Cast, Model, Tray, Ortho, Ortho Plus, Ortho Flex, Gingiva)

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

TempoCemNE

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

TempoCem

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Variable Speed Amalgamator

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Premium Dispersed Phase Amalgam Alloy (Fast & Regular Set)

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

MixStar eMotion Mixing Machine

5	4	3	2	1
5Item #1 5	4Item #1 4	3Item #1 3	2Item #1 2	1Item #1 1

Thank you for participating in this survey! We appreciate your feedback to help DMG continuously improve our products and service offerings.

Phone

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Phone description Lab

Practice Name *

Doctor's Name *

Contact First Name (Responsible for Workflow) *

Contact Last Name *

Contact Email *

Contact Phone *

Practice Address *

Practice City *

Practice State *

Practice Zipcode *

Interested in: *

Splints
Bleaching Trays

Dealer

Hub Lab of Choice *

Date of First Case *

Notes (include description of workflow)

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