MEDEQUINE PERFORMANCE EVALUATION

MEDEQUINE is an equine cosmetic, used to promote healthy-looking skin and coat.  The product may have curative properties.  By completing this questionnaire, you will help us guide our Veterinary research program.  Thank you for your cooperation.  Empire Pharmaceutical, Inc., May, 2005

Please fill out the form below and click on the submit button located at the bottom of this page.

If you have any questions please call 1-703-690-3744, or e-mail: studies@usamediainc.com.

Please provide the following information:   (All information will be held in confidence.)

Organization   (if any.)
First Name
Last Name
Street Address or P.O. Box   
City  
State or Province  
Zip or Postal Code
Country
Telephone
E-mail  Your e-mail address will not be used for solicitation.
Fax Number Your fax number will not be used for solicitation.
  Please Mark one of the Following Categories
I am a Veterinarian.
I am an Owner.
Other.
Horse Name   .
Age   .
Breed   .

Gender (Female, Male or Gelding):

Female.
Male.
Gelding.

Skin/Hoof or Coat Condition:

Ringworm.
Rain Rot.
Muck Itch.
White Line.
Insect Bites.
Allergy.
 (List More Details about Condition, if necessary.)   .
Probable Infecting Organism:   .
Estimated Size:   measured by length and width.

Was diagnosis made by a Veterinarian ?

Yes.
No.
If yes, type the name of the Veterinarian:  .

           Please describe the affected area, e.g. head, neck, mane, tail, hoofs (any hoof or hoofs):

Prior to using MedEquine, how long had the horse suffered from this condition?    type number of days or weeks (indicate whether days or weeks).
Period of time that MedEquine was used?   type number of days or weeks (indicate whether days or weeks).
How many times a day did you apply MedEquine?   times per day.
How much total MedEquine did you use?   22 oz. bottles.

How well did MedEquine treat the infection?

Completely.
Moderately.
Not at all.
Was there any other therapy used along with the MedEquine?   If Yes,  identify which drug or other form of therapy you used.

What criteria did you use to evaluate MedEquine’s performance?

Scabbing.
Hair loss (Alopecia).
Flaking.
Redness or Swelling.
Hair Discoloration.
Microbiological Culture.
Rubbing-Itching-Biting.

              Other, please describe: 

 

To what extent did MedEquine improve the appearance of the coat?

Completely.
Moderately.
Slightly.
Not at All.
How many days until the condition completely healed?   days.
After stopping MedEquine, how long did the healing persist ?   days (as of this date).
Did MedEquine cause any side effects?   (yes or no).      If Yes, please describe.

Did MedEquine prevent the spread of the condition?

Yes.
No.

How does MedEquine compare to other products and treatments you have used? (Please Mark one of the Following Categories.)

More Effective.
Equally Effective.
Less Effective.

How does MedEquine compare to other products and treatments you have used in terms of ease of use? (Please Mark one of the Following Categories.)

Easier to use.
Less easier to use.

How does MedEquine compare to other products and treatments you have used in terms of the horse? (Please Mark one of the Following Categories.)

Less Harsh to the Horse.
More Harsh to the Horse.

Please list other products or treatments you have used for the same condition:

 

Do you plan to use MedEquine in the future?

Yes, definitely.
Probably.
Maybe.
No, never.

Additional comments:

Date this form was completed.  .

IF YOU WANT A PRINTED COPY OF YOUR COMPLETED QUESTIONNAIRE FOR YOUR RECORDS YOU MUST PRINT THIS FORM PRIOR TO CLICKING ON THE SUBMIT BUTTON.

    


© 2005 USA Media, Inc. d/b/a/ USA Distributors-Empire Pharmaceutical, Inc. All Rights Reserved.