:Poll

 
 
 
 Name of clinic :
   Clinic agent name :
 Sex :
  male 
  female 
 Official state of the agent :
       Tel :
 Kind of assessment :
private     
governmental  
    
 Kind of activity :
expert         
  proficient              others              
        Add :
  Province :
                         City :
         Tel :
                         Fax :
 postcode :
                      Email :
 Kind of purches :
Market         
Distribution co
Agency      
Direct           
 Kind of price evolution :
Customers & market        
Company responsible    
Distribution office Inquiry   
 Method of payment :

3-4 Months   

 2-3 Months      

  1-2 Months    

In cash          
 Amount of purchases in  clinics :
Very high         
High     
Average      
Low          

  Which one is of more importance in your clinic?          

Price         
Quality      
Both and in the same rate
 
  Do you know any other Latif's products?           
Yes
No
  As one consumer of Latif products what is the state of our success in providing your needs?             
Successful
Unsuccessful
    

 Have you ever purchased Latif products? (Please write them below)

 How did you know our products?
Catalog 
Distribution co 
Scientific agent 
Website 
Press
 

 Which one is among the advantages of Latif products?
Reasonable price in competition with other rivals  
Style of package     
Products' high quality
Short time of dispatching the others
Other
 Are you interested in using our products?
Yes 
No               
 

 If yes which products are the most favorable ones among Latif products?


 In case of more advantages and gifts as well as extra services do you prefer to have permanent contact with this  company to satisfy all your needs?
Yes 
No
 

 If no, which preventive factors influence this permanent contact?(please write them in the box bellow).     
                                                                                                          
 
User Name
 
Password
 
 
   
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