Physicians' Office Update Contact Form

* E-mail:
* Phone:


* Full Name:  

* Address:  
Address 2:


* City:  
* State:  
* Zip:  


Is this the address of your practice?


1. How many patients do you see on a weekly basis?



2. How many laundry product discussions do you have with these patients in a typical week?

 


3. Which of the following laundry detergents do you recommend? Please check all that apply.

all® free clear Cheer® free & gentle Dreft® Tide® free & gentle™
Any free clear detergent


Other and why?:


4. Which of the following liquid fabric softeners and/or dryer sheets do you recommend? Please check all that apply.

all® free clear liquid fabric softener all® free clear dryer sheets Ultra Downy® Free & Gentle™ liquid fabric softener
Bounce® Free & Gentle dryer sheets I don't recommend liquid fabric softeners I don't recommend dryer sheets


Other:


5. How often would you like to receive all® free clear samples at your office?



6. During which allergy seasons are you most likely to make a laundry product recommendation? Please check all that apply.
Spring Fall Winter Summer     

Other (non-aeroallergen related):




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