Thank you for trying CoolJect TargetedMist!
Complete these 6 quick questions and we will ship another complimentary canister. *Limit on Promo #1 to one per physician.
Do you use a topical anesthetic for every injection and every needle procedure?
*
Yes
No
What topical anesthetic spray is your facility currently purchasing?
*
Ethyl Chloride
Pain Ease
CryoDose
Other
If using Ethyl Chloride, are you aware it is classified as a Cat. 4 substance and is known to cause cancer?
Yes
No
When spraying a competitive topical anesthetic, do you count or spray to blanching?
*
4 seconds
5 seconds
6 seconds
7 seconds
8 seconds
9 seconds
10 seconds
Blanching
When using CoolJect, do you spray to blanching or count to 4 seconds?
*
4 seconds
Blanching
When using CoolJect, approximately how far do you hold the nozzle from the patient's skin?
*
3 inches
4-7 inches
Facility/Practice Name:
Your Name:
First Name
Last Name
Your Title:
Your Practice Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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