Survey

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Survey

Name of Individual/Organization *

Place *

Email ID *

Mobile Number *

Average Monthly Purchase *

Monthly Requirements (Average) *

Syringes with Needles

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
1 ML
2.5 ML
3 ML
5 ML
10 ML
20 ML
50 ML

IV Canula with wings

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
14 G
16 G
18 G
20 G
22 G
24 G

Cotton Balls

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
0.5 gm
0.75 gm
1 gm
2 gm
5 gm

Under pads

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
Small
Medium
Large
XL
XXL

Diaper

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
Small
Medium
Large
XL
XXL

Scalp Vein Sets (SVZ's)

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
20 G
22 G
23 G
24 G

Adhesive Tapes (10 yds)

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
0.5 inch
1 inch
2 inch
3 inch

Needles

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
18 G
23 G
24 G
26 G

Other Quantity in Numbers

	0 - 50 No's	50 - 100 No's	100 - 250 No's	250 - 500 No's	More than 500	Not applicable
3 Ply Masks
Alcohol Swabs
Bandages
Gauze
Cannula Fixator
Surgeon Gowns
Surgeon Caps
Distilled Water

Would you like to know how you can buy all the mentioned products in one KOGLAND BOX? * Yes No

Do you want to activate SPECIAL B2B registration for special offers and discounts (FREE OF COST)? * Yes No