Directions: Please fill out form and either: 1) click "submit" to email form; or 2) print and fax to (623) 465-2888; or 3) print and mail to: South West Orthopedic Designs, 36602 N. 16th St., Phoenix, AZ 85086.
Thank you for your purchase of the South West Ankle Brace. In order to better serve you, please take a few moments to fill out this brief questionnaire and warranty registration by checking the appropriate boxes and filling in the information where requested.
1) How did you learn about the South West Ankle Brace? Doctor Orthotist Internet Magazine/journal Friend Other:
2) Did you receive your brace in the time you anticipated? Yes No Was never given a time-frame If no, please explain:
3) Does the brace meet your expectations in appearance? Exceeds expectations Meets expectations Below expecations If below, please explain:
4) Does the brace meet your expectations in comfort? Exceeds expectations Meets expectations Below expectations If below, please explain:
5) How does the South West Ankle Brace compare to other braces you've had in the past? Better About the same Not as good First Brace If not as good, please explain:
6) Additonal comments and suggestions:
____________Name: __________Address: _City, State, ZipCode: ____Phone (optional): Doctor/Orthotist name:
Yes, you may use my comments for marketing purposes. No, you may not use my comments.
After completing the survey and registration, please click "Submit" below (or) print, fax/mail. Thank you for participating in our survey and warranty registration. Please feel free to call or email us if you have any questions.