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SAMPLES DETAILED QUESTIONNAIRE Needed to Process CYMED Samples

NOTE: PLEASE READ - Estimated completion time 5-10 minutes. AFTER Q#43 THERE IS STILL ONE MORE QUESTION REQUIRED. All Questions in BOLD black letters must be answered to successfully submit this Samples Ticket. If your Ticket is not closing, please review and make sure all those are answered(the last two Questions are not numbered and are required by the software). ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL AND WILL NOT BE USED FOR ANY MARKETING.

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OSTOMY DETAILS

The answers to these questions help us find the best product match. Please take the time to answer them as fully as possible. Thank you

PRODUCT PREFERENCES

The answers to these questions help us find the best product match. Please take the time to answer them as fully as possible. Thank you

TICKET CLOSING

AN ENTRY IS REQUIRED (BY THE SOFTWARE) FOR THE NEXT TWO FIELDS, TO COMPLETE THE SUPPORT TICKET. Thank you for your understanding.
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