Manufacturing innovative products for the dental professional for over 75 years

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  Order Number:

This can be found on your packing slip if you received the product directly from
Pascal Company, Inc. Leave blank if you received the product from a distributor.
   
 
  *Product:

     
* 1. Did you receive your product in a timely manner?  
* 2. Was your shipment received in good condition?  
* 3. Is the product packaging to your liking?  
* 4. Were the instructions easily understood?  
* 5. Is the product easy to use?  
* 6. Have you used this product before?  
* 7. Flavor?  
* 8. Scent?  
* 9. Effectiveness  
     
Comments / Suggestions:
 
 
  * Practice Name:
   
  * Contact:
   
  * Email:
   
  Address:
   
  Phone:
   
  * Required Field