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Personal Information
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*Name
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*Contact Name
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*Address
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*City
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*State
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*Zip Code
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*Country
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*E-mail
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Website
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*Phone
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Fax
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Please Enter your Product Serial Numbers
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| MagnaVu Serials |
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| MagnaLux Serials |
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Purchase Information
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*Purchased From
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*Dealer Name
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*Date Purchased
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(mm/dd/yyyy)
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*Date Installed
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(mm/dd/yyyy)
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*Date of Training
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(mm/dd/yyyy)
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Reason for Purchase
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| Please rank from the top reason to the lowest reason, with 10 being the highest and 1 being the lowest. |
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Reduce Fatigue and Strain
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Increase Years of Practice
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Increase Magnification
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Improve Lighting
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Perform Better Dentistry
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Prevent Future Problems
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Increase Production
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Recording and Archiving
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Teaching and Training
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For VELscope Oral Cancer Device
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Your Practice
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How many years in practice
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Years intending to continue practice
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Number of Operatories
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Number of Ops with MagnaVu
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Number Planned in the Future
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Number of Ops with MagnaLux
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Number Planned in the Future
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Were you happy with Installation
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| Please Explain |
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Were you happy with Training
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| Please Explain |
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Can your Local Dealer use your name as a Referral to other dentists in your area?
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Can your Local Dealer bring other Potential Customers by your Practice to see your system in use?
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If Yes, when?
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How did you learn about our Products?
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Did you compare our products with other products before purchase?
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If Yes, which ones?
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Did you purchase the optional MVD extended warranty and non-obsolescence plan, our Customer Service Advantage Plan at the time of purchase?
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Would you be interested in participating in product use and improvement surveys?
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Please keep me informed by email about product updates, useful tips, advanced training, and user tips. We value your privacy and security and do not sell or share our customer list.
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We know your time is valuable and we appreciate you filling out this product registration and survey form. It helps us create better products for your future.
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We would love to hear from you. Please send us pictures of your systems in use and tell us about your experiences and what our products have done for your practice. We would love to share them with others. Please email them to info@magnavu.com.
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