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  PRODUCT FEEDBACK  
 
Thank you for choosing Therafirm compression products. We value your feedback on how well your Therafirm product met your needs. Take our brief Customer Satisfaction Survey and be entered into a monthly drawing for 3 FREE poducts of your choice. *
 

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
Have you worn compression hosiery before? Yes
No
If yes, what brand?
Date of Purchase (MM/YY)
Which style did you purchase at this time? Knee
Thigh
Full/Pantyhose
What compression level? 10-15mmHg Light Support
15-20mmHg Mild Support
20-30mmHg Moderate Support
30-40mmHg Firm Support
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
Where did you purchase your THERAFIRM product? Medical Supply Shop
Drug Store
Catalog
Internet
Discount Store
Other
If other, please specify:
How many pairs did you purchase? 1
2
3
4
5
Other

On a scale of 1 to 10 how would you rate the following (with 10 being the best and 1 being the worst):
 
1
2
3
4
5
6
7
8
9
10
Quality
 
Fit
 
Comfort
 
Price
 
Overall Satisfaction
                     
Would you be willing to help us with future projects or in testing new products? Yes
No
Comments / Questions:
We occasionally send special promos or new product information to customers. Would you like to receive these special offers? Yes
No
Please provide your E-Mail Address if you would like to receive promos or new product information.
 

* Currently only for US and Canadian residents.