Thank you for taking the time to complete this brief survey. Your input will help us improve our products and services and help more patients.

We respect your personal information and privacy. The information you provide us will only be shared with companies working with Organogenesis for purposes relating to our programs, products and services and not for any other use.

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! Some errors were found. Please correct the fields indicated below: ! Please answer at least one question prior to submitting the survey. If possible, provide answers to all questions. Your participation is highly appreciated. 1. Please describe yourself. Are you? A patient A caregiver (friend, family or professional caregiver) A healthcare professional: Doctor Nurse Other 2. How did you initially hear about us? (Please choose as many as apply) I saw a magazine advertisement I read /saw/heard a news article or news program in either the newspaper, TV, and or radio The nurse or doctor told me about Apligraf® A friend told me about Apligraf® My son/daughter/family member/ or caregiver told me about Apligraf® I did an internet search on wounds, and I found the Apligraf® site as a result of my search There was an internet ad on a search engine that led me to this site The Apligraf® call center referred me here A brochure the doctor/nurse gave me led me to this site Other 3. What is your year of birth?    Please enter valid 4-digit year 4. Are you interested in treatment for diabetic foot ulcers or venous ulcers? Diabetic Foot Ulcers Venous Ulcers Both Unsure 5. Would you like to receive additional information on Apligraf® such as newsletters and updates from Organogenesis, Inc. (the makers of Apligraf®)? Yes I wish to receive information on Apligraf® No, I do not wish to receive information on Apligraf® 6. Would you be willing to have us contact you on occasion to participate in wound care market research studies sponsored by Organogenesis, Inc.? Yes, I wish to be contacted to be invited to participate in market research. No, I do not wish to be contacted to be invited to participate in market research. 7. What best describes the current treatment you receive for your wound? Cared for by family physician Cared for by podiatrist Cared for by physician at Wound Center Cared for by visiting nurse or home health care work Other If you've answered YES to either 5 or 6, please provide the following information: E-mail: * Please enter a valid e-mail address Enter code shown in the picture on the right:* (not case sensitive) Please enter the code as shown in the image to the right. Incorrect code value. Please re-enter the code as shown in the image to the right.       Submit