Product Feedback

First Name:

Last Name:

Address

City:

State:

Zip Code:

E-mail Address

Phone Number:

Are you?

Male
Female

Are You?

Under 35
36-45
46-55
56-65
66-75
75+

Your annual household income:

Under $20,000
$20,001-$39,999
$40,000-$59,999
Over $60,000

1. What Knit-Rite brand did you purchase at this time? If feedback is for a compression product proceed to question #2. If feedback is for SmartKnit, SmartKnitKIDS, or Therasock products please skip to question #7.

Therafirm
Ease
Core-Spun
TherafirmLight
Core-Sport
GOGO by Therafirm
Preggers by Therafirm
SmartKnit
SmartKnitKIDS
Therasock

2. Have you worn compression hosiery before?

Yes
No

3. If yes, what brand?

4. Date of Purchase (MM/YY)

5. Which style did you purchase at this time?

Knee
Thigh
Full/Pantyhose

6. What compression level?

10-15mmHg Light Support
15-20mmHg Mild Support
20-30mmHg Moderate Support
30-40mmHg Firm Support

7. Please provided the 11 digit LOT# that is located on the bottom label of the box.

8. Where did you purchase your Knit-Rite product?

Medical Supply Shop
Drug Store
Catalog
Internet
Discount Store
Other

9. What caused you to purchase? (Check all that apply)

Information at the point of purchase
Referral by a medical professional
Suggestion of a friend/acquaintance
Print advertisement
Information on package
Other

9a. If other, please specify:

10. How many pairs did you purchase?

1
2
3
4
5
Other

11. On a scale of 1 to 10 how would you rate the following:

Quality

1
2
3
4
5
6
7
8
9
10

Fit

1
2
3
4
5
6
7
8
9
10

Comfort

1
2
3
4
5
6
7
8
9
10

Price

1
2
3
4
5
6
7
8
9
10

Overall Satisfaction

1
2
3
4
5
6
7
8
9
10

12. Would you be willing to help us with future projects or in testing new products?

Yes
No

13. Comments / Questions:

14. We occasionally send special promos or new product information to customers. Would you like to receive these special offers?

Yes
No

15. Please provide your E-Mail Address if you would like to receive promos or new product information.