Facial Aesthetics Survey 1.5 Sale Dental Spa Question Title * 1. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 2. How many children are you a parent or guardian to in your household (aged 17 or younger)? None 1 2 3 4 More than 4 Question Title * 3. When choosing a Botox/Fillers provider, which of the following factors is most important to you? Price Clinician experience Online reviews Recomendation from friends Location Style and sophistication of service/venue Other (please specify) Question Title * 4. What are you looking to achieve with treatment? Look younger Find a partner Look younger for your partner Prevent signs of old age Improve career Just trying something new for a change Other (please specify) Question Title * 5. How would you describe your style/fashion type? Question Title * 6. What are your concerns of having Botox/Fillers? Please be specific. Question Title * 7. Would you be interested in attending an event to learn more about Botox/Fillers? Yes No Question Title * 8. What else would you consider improving about yourself after having Botox/Fillers? Question Title * 9. Has a recent purchase made you consider getting Botox/Fillers? If yes, please describe. Question Title * 10. Please enter details where we can notify you if you win. Please complete ALL sections. Name Company City/Town Postal Code Occupation Email Address Phone Number Enter Prize Draw