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99.86.7.27  Public Scan

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Submitted URL: https://deno.encapsedisc.de/link.php?M=9472551&N=1521&L=467&F=H
Effective URL: https://www.surveymonkey.com/r/PierreFabreSurvey
Submission: On May 18 via manual from IN — Scanned from DE

Form analysis 1 forms found in the DOM

Name: 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" style="width:px;
            
            
            
            ">
          <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
                    ">
                  <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
                    ">
                  <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
                    ">
                  <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">
                <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">
                  <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 "> &lt;1-2 years </span>
                    </label>
                  </div>
                </div>
                <div class="answer-option-cell">
                  <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">
                  <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">
                  <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 "> &gt;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="4FoTYerhlqpl9PSGmuD5IeDmXMi_2FzYBDEMVW_2F1AyEf6cahr1UwhMAqHKwLWF5_2BVuy5YmtQNRijpz4ZeB7Qd1tTsOhaFOKW874TXq0Azw8YxYxfCg9ScGzkLArkJnUg37LnkYAEMvuFAWTi3jrfjU0f9s99lQAmCpYjuUtCvAMLj02aqTtfik0X7505rNjx71l_2BA3zqGYmZK20a9wQGN7QO0SZHsNKpQ5pKpph_2BZ_2BW5_2FTKz_2F7H0L6lOnmZt_2Fs9Y_2F8NjGqufXy8Bk_2Fib4sz_2FhaCiFPxXflyxaLf_2FWpMktRZO2tUO0HQ_2BBvZD4OGkNBpKhYT7EkBw5U0nbD1sYPC64KB8r4L06XexrUH9scGNX1nlX0bpa9HOzIpmHHpN0Xja_2FMurhdjyoijum_2FhObU5rOCS_2FZ2iFLQYSobuTHvr_2BF4GaWcw9kHf0mPmvTipNzVW802SYj6OyXzt0U98T1nCjCYfPDmtw7xP1Nc5vPtG7AyFeWcUNu5D7N09YHtOigDzGgPyha14ugil7hB3gsk6PU9qV_2BOHpSFmPna46cNdMxS0raDnMY_2FPYtC9doG6Swv85GE">
  <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

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