1. Where did you purchase NeilMed's SinusRinse™ products?
Physician  Pharmacy  Mail Order  Gift  Other If Other, specify
2.  What was your previous method of nasal rinse?
SinusRinse™ by NeilMed  Bulb Syringe  Saline Spray Saline solution in the palm and sniffing Electrical irrigation None
3. How would you compare SINUS RINSE™ or NasaFlo® Neti Pot to others?
Superior	Same	Inferior
4.  What is your overall rating of the SinusRinse™ or NasaFlo® Neti Pot?
Excellent  Good  Satisfactory  Needs Improvement
Comments:
5.  Would you recommend NeilMed's SinusRinse™ or NasaFlo® Neti Pot?
Yes	No
6. Did your condition improve by using SinusRinse™ or NasaFlo® Neti Pot?
Significantly	Moderately	Mildly	No improvement
7a. How often do you use the SinusRinse™ or NasaFlo ® Neti Pot?
Once a day	Twice a day	Every other day	As needed
7b. Do you use the SinusRinse™ or NasaFlo ® Neti Pot.....
Seasonally	Throughout the Year
8. With NeilMed's SinusRinse™ or NasaFlo® Neti Pot, was there a change in...
Not Applicable No Change Reduced Stopped Using ..use of antihistamines? ..use of corticosteroid nasal sprays? ..use of OTC nasal decongestants? ..frequency of antibiotic therapy? ..asthma related symptoms?
9. Did frequency of sinus infections or colds, reduce with the use of NeilMed's SinusRinse™ or NasaFlo® Neti Pot?
Stopped Completely	Reduced	No Change
10. How do you feel about the price of our product compared to other Systems on the market?
Priced too low  Reasonably priced  Priced too high
11. Did you experience any immediate side effects with NeilMed's SinusRinse™ or NasaFlo® Neti Pot? (check all applicable)
None  Headache  Earache  Watery eyes  Congested nose  Nasal burning
12. What was the duration of any side effects?
Minutes  Few hours  A day  Up to 3 days  A week
13. Did side effects prevent you from using NeilMed's SinusRinse ™ or NasaFlo® Neti Pot?
Yes	No
14. Did the benefits outweigh the side effects of using NeilMed's SinusRinse™ or NasaFlo® Neti Pot?
Yes	No
15.  Any additional Comments/Suggestions:

1. Are you a NasaMist® or NasoGel® user?
NasaMist®	NasoGel ®
2. Where did you purchase NeilMed NasaMist® or NasoGel® ?
Physician  Pharmacy  Mail Order  Gift  Other If Other, specify
3. What nasal gel product(s) have you used previously?
4. What nasal saline spray(s) have you used previously?
5. How would you compare your NeilMed product?
Superior	Same	Inferior
6.  What is your overall rating of the NasaMist® or NasoGel®?
Excellent  Good  Satisfactory  Needs Improvement Comments/Suggestions
7.  Would you recommend NeilMed's NasaMist® or NasoGel®?
Yes	No
8.Did your nasal dryness condition improve by using the NeilMed® NasaMist® or NasoGel®?
Significantly  Moderately  Mildly  No improvement
9. How often do you use the NeilMed® NasaMist® Saline Spray or NasoGel®?
Once a day  Twice a day  Every other day  As needed
10. After using NeilMed® NasaMist® Saline Spray or NasoGel®, was there a change in the use of other medications?
Not Applicable	No Change	Reduced	Stopped Using
11. Are you using oxygen?
Yes	No
12. Are you using CPAP for obstructive sleep apnea?
Yes	No
13. What is the duration of benefit?
1hr  2hr  3hr  4hr  5hr  6hr
14. Did the frequency of sinus infections or colds reduce with the use of NasaMist® Saline Spray or NasoGel® by keeping the nose moist?
Stopped Completely	Reduced	No Change
15. How do you feel about the price of our product compared to other systems on the market?
Priced too low	Reasonably priced	Priced too high
16. Did you experience any immediate side effects with NasaMist® Saline Spray or NasoGel®? (check all applicable)
None	Headache	Earache
Watery of eyes	Congested nose	Nasal burning
17. What was the duration of any side effects?
Minutes	Few hours	A day
18. Did side effects prevent you from using NeilMed NasaMist® or NasoGel®?
Yes	No
19. Did the benefits outweigh the side effects of using NeilMed NasaMist® or NasoGel®?
Yes	No
20.  Any additional Comments/Suggestions:
21. I will go to the store to purchase NeilMed® NasaMist® Saline Spray or NasoGel® products.
Yes	No