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Lidocaine Oral Thin Film Questionnaire For Dentists
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Dental Clinic Name
*
Your answer
1. Where did you apply the film?
Tongue
Buccal
Upper Gums (Maxillary Gingiva)
Lower Gums (Mandibular Gingiva)
Placement under tongue
Upper Palate Left and right side
2. Was additional freezing needed?
*
Yes
No
3. Was there any residue visible during the appointment?
*
Yes
No
4. Did you apply the entire film or alter it in any manner?
*
Yes
No
Other:
5. Did the film stay in the intended spot prior to dissolving?
*
Yes
No
6. Was opening the packaging easy or difficult?
*
Easy
Moderate
Difficult
7. Was the size and shape of the film appropriate for the application?
*
Yes
No
8. What procedure was the film applied for?
*
Cleaning
Surgical Prep
Post op surgery
Injury Relief
Others, Ulcers sores or trauma
Required
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