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Submitted URL: http://deno.comapcabel.co.in/link.php?m=18949676&n=2485&l=467&f=h
Effective URL: https://www.surveymonkey.com/r/PierreFabreSurvey
Submission: On March 05 via api from US — Scanned from US
Effective URL: https://www.surveymonkey.com/r/PierreFabreSurvey
Submission: On March 05 via api from US — Scanned from US
Form analysis
1 forms found in the DOMName: surveyForm — POST
<form name="surveyForm" action="" method="post" enctype="multipart/form-data" novalidate="" data-survey-page-form="">
<div class="questions clearfix">
<div class="question-row clearfix
">
<div data-question-type="open_ended_single" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-761004883" data-qnumber="1" data-qdispnumber="1" data-question-id="761004883" class=" question-open-ended-single qn question single question-required">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-761004883" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 1<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Please enter your name (first name, last name).</span>
</h4>
<div class="question-body clearfix notranslate ">
<div id="open-ended-single_761004883" data-question-id="761004883" data-response="" data-sm-open-single="" maxlength="20000" data-ng="true" data-required="true" data-size="50" data-labeledby="question-title-761004883">
<div class="question-body open-ended-single"><input aria-labelledby="question-title-761004883" id="761004883" aria-required="true" data-sm-open-single="true" maxlength="20000" class="wds-input wds-input--lg qt-input_text text"
name="761004883" size="50" value=""></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="open_ended_single" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-761004936" data-qnumber="2" data-qdispnumber="2" data-question-id="761004936" class=" question-open-ended-single qn question single question-required">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-761004936" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 2<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Please enter the name of your practice (office/clinic/hospital).</span>
</h4>
<div class="question-body clearfix notranslate ">
<div id="open-ended-single_761004936" data-question-id="761004936" data-response="" data-sm-open-single="" maxlength="20000" data-ng="true" data-required="true" data-size="50" data-labeledby="question-title-761004936">
<div class="question-body open-ended-single"><input aria-labelledby="question-title-761004936" id="761004936" aria-required="true" data-sm-open-single="true" maxlength="20000" class="wds-input wds-input--lg qt-input_text text"
name="761004936" size="50" value=""></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="open_ended_single" data-rq-question-type="open_ended" class="question-container
">
<div id="question-field-761005099" data-qnumber="3" data-qdispnumber="3" data-question-id="761005099" class=" question-open-ended-single qn question single question-required">
<h3 class="screenreader-only">Question Title</h3>
<div class=" question-fieldset question-legend">
<h4 id="question-title-761005099" class=" question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 3<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> Please enter your primary practice location (city, state).</span>
</h4>
<div class="question-body clearfix notranslate ">
<div id="open-ended-single_761005099" data-question-id="761005099" data-response="" data-sm-open-single="" maxlength="20000" data-ng="true" data-required="true" data-size="50" data-labeledby="question-title-761005099">
<div class="question-body open-ended-single"><input aria-labelledby="question-title-761005099" id="761005099" aria-required="true" data-sm-open-single="true" maxlength="20000" class="wds-input wds-input--lg qt-input_text text"
name="761005099" size="50" value=""></div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="multiple_choice_vertical" data-rq-question-type="multiple_choice_vertical" class="question-container
">
<div id="question-field-761002804" data-qnumber="4" data-qdispnumber="4" data-question-id="761002804" class=" question-multiple-choice qn question vertical question-required">
<h3 class="screenreader-only">Question Title</h3>
<fieldset class=" question-fieldset">
<legend class="question-legend">
<h4 id="question-title-761002804" class="
question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 4<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> How would you describe your practice specialty? (Check all that apply)</span>
</h4>
</legend>
<div class="question-body clearfix notranslate ">
<div class="">
<div class="answer-option-cell
" data-answer-id="5037151789">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="761002804_5037151789" name="761002804[]" type="checkbox" class="checkbox-button-input " value="5037151789">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="761002804_5037151789">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Medical dermatology </span>
</label>
</div>
</div>
<div class="answer-option-cell
" data-answer-id="5037151790">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="761002804_5037151790" name="761002804[]" type="checkbox" class="checkbox-button-input " value="5037151790">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="761002804_5037151790">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Cosmetic dermatology </span>
</label>
</div>
</div>
<div class="answer-option-cell
" data-answer-id="5037151791">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="761002804_5037151791" name="761002804[]" type="checkbox" class="checkbox-button-input " value="5037151791">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="761002804_5037151791">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Medical spa </span>
</label>
</div>
</div>
</div>
<div class="other-answer-container other-answer-option-container" data-answer-id="5037170610">
<div data-sm-checkbox="" class="checkbox-button-container ">
<input id="761002804_5037170610" name="761002804[]" type="checkbox" class="checkbox-button-input " value="5037170610" data-other-answer="">
<label class="answer-label checkbox-button-label no-touch touch-sensitive clearfix" for="761002804_5037170610">
<span class="checkbox-button-display ">
</span>
<span class="checkbox-button-label-text question-body-font-theme user-generated "> Other (please specify) </span>
</label>
</div>
<textarea id="761002804_other" name="761002804_other" class="textarea other-answer-text" maxlength="20000" rows="3" cols="50" aria-label="Other (please specify)" data-other-text=""></textarea>
</div>
</div>
</fieldset>
</div>
</div>
</div>
<div class="question-row clearfix
">
<div data-question-type="single_choice_vertical" data-rq-question-type="single_choice_vertical" class="question-container
">
<div id="question-field-761006486" data-qnumber="5" data-qdispnumber="5" data-question-id="761006486" class=" question-single-choice-radio qn question vertical question-required">
<h3 class="screenreader-only">Question Title</h3>
<fieldset class=" question-fieldset" data-radio-button-group="">
<legend class="question-legend">
<h4 id="question-title-761006486" class="
question-title-container ">
<span class="required-asterisk notranslate"> * </span>
<span class="question-number notranslate"> 5<span class="question-dot">.</span>
</span>
<span class="user-generated notranslate
"> How long have you been in practice?</span>
</h4>
</legend>
<div class="question-body clearfix notranslate ">
<div class="">
<div class="answer-option-cell" data-answer-id="5037174477">
<div data-sm-radio-button="" class="radio-button-container " aria-labelledby="question-title-761006486">
<input id="761006486_5037174477" aria-labelledby="761006486_5037174477_label" name="761006486" type="radio" role="radio" class="radio-button-input " value="5037174477" aria-checked="false">
<label data-sm-radio-button-label="" id="761006486_5037174477_label" class="answer-label radio-button-label no-touch touch-sensitive clearfix" for="761006486_5037174477">
<span class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated "> <1-2 years </span>
</label>
</div>
</div>
<div class="answer-option-cell" data-answer-id="5037174478">
<div data-sm-radio-button="" class="radio-button-container " aria-labelledby="question-title-761006486">
<input id="761006486_5037174478" aria-labelledby="761006486_5037174478_label" name="761006486" type="radio" role="radio" class="radio-button-input " value="5037174478" aria-checked="false">
<label data-sm-radio-button-label="" id="761006486_5037174478_label" class="answer-label radio-button-label no-touch touch-sensitive clearfix" for="761006486_5037174478">
<span class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated "> 3-5 years </span>
</label>
</div>
</div>
<div class="answer-option-cell" data-answer-id="5037174479">
<div data-sm-radio-button="" class="radio-button-container " aria-labelledby="question-title-761006486">
<input id="761006486_5037174479" aria-labelledby="761006486_5037174479_label" name="761006486" type="radio" role="radio" class="radio-button-input " value="5037174479" aria-checked="false">
<label data-sm-radio-button-label="" id="761006486_5037174479_label" class="answer-label radio-button-label no-touch touch-sensitive clearfix" for="761006486_5037174479">
<span class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated "> 6-10 years </span>
</label>
</div>
</div>
<div class="answer-option-cell" data-answer-id="5037174480">
<div data-sm-radio-button="" class="radio-button-container " aria-labelledby="question-title-761006486">
<input id="761006486_5037174480" aria-labelledby="761006486_5037174480_label" name="761006486" type="radio" role="radio" class="radio-button-input " value="5037174480" aria-checked="false">
<label data-sm-radio-button-label="" id="761006486_5037174480_label" class="answer-label radio-button-label no-touch touch-sensitive clearfix" for="761006486_5037174480">
<span class="radio-button-display ">
</span>
<span class="radio-button-label-text question-body-font-theme user-generated "> >10 years </span>
</label>
</div>
</div>
</div>
</div>
</fieldset>
</div>
</div>
</div>
</div>
<div class="survey-submit-actions center-text clearfix">
<button type="submit" data-submit-page-button="" class="btn small next-button survey-page-button user-generated notranslate"> Next </button>
</div>
<input type="hidden" id="survey_data" name="survey_data"
value="c0BEbA7iDy16YeLYMbA3PBT5bPbYsOiR0T2zG9ClbUwFCKJB3738Z_2Frw8PT_2Fxz0L_2BEFa75Wtu71OEZJFZd_2BA2iwnKJ3rZtVUWeOXKWlnB0U57xB2XV_2B072WDR9l51bOu4hn_2Fk5rSbwPZhLAyrIsm2_2BruEnFRTi6vfA3_2B_2Bu0HeAoRXp_2BVXT5jthKkb8YqFR15eZTrc_2FdEl0w0kdM_2FsuwZpAT2p_2BgB241qB1sbkgsIBB6rDUOnL9m8YrWjBdt7RcLPo6vHJsWYGgeW8K91dQzR_2FdSu7BNO_2B0qSEp2mArBrJEXSiirhdwZLdQPGPYLc98F_2FvkVSLJ2LIU6LhmHPSUK83g9ppO5b3FIQef8lyPD6w9ppxbWxmB45c9CM7TeVGw4oJwDFZbvzwO9X8KMF9FZwPMH9ZxpTHcvOfh4ku62T6IMmJVnLia_2BFz_2B2erHT5bkUdjykYPH7beRpD4XQ_2BuyNJ5pwmi3Gs_2BboX1ueYXDr_2FlSEHNVTyIKk1Vs44zZe57RxFwEGlcezyj07Hs4wPmpQd_2FO_2BWrvrZlwRzVL9Ol2YV8yMugi0xOOrFDkwU92Uhx9CkCFOIh_2BXRGtudCa6WXWnog96Rem_2BFlWo7lKiwz9Vv66A_3D">
<input type="hidden" data-response-quality="" id="response_quality_data" name="response_quality_data" value="{}">
<input type="hidden" id="is_previous" name="is_previous" value="false">
<input type="hidden" id="disable_survey_buttons_on_submit" name="disable_survey_buttons_on_submit" value="">
</form>
Text Content
KOL ENGAGEMENT SURVEY QUESTION TITLE * 1. PLEASE ENTER YOUR NAME (FIRST NAME, LAST NAME). QUESTION TITLE * 2. PLEASE ENTER THE NAME OF YOUR PRACTICE (OFFICE/CLINIC/HOSPITAL). QUESTION TITLE * 3. PLEASE ENTER YOUR PRIMARY PRACTICE LOCATION (CITY, STATE). QUESTION TITLE * 4. HOW WOULD YOU DESCRIBE YOUR PRACTICE SPECIALTY? (CHECK ALL THAT APPLY) Medical dermatology Cosmetic dermatology Medical spa Other (please specify) QUESTION TITLE * 5. HOW LONG HAVE YOU BEEN IN PRACTICE? <1-2 years 3-5 years 6-10 years >10 years Next Powered by See how easy it is to create surveys and forms. Privacy & Cookie Notice Javascript is required for this site to function, please enable.