Application for Therapists for Sales Consultant Program, Fun and Function Survey

1. Please respond to our questionnaire to be considered for our Sales Consultant Program.

You may be contacted for a phone or in-person interview. All responses are completely confidential and will not be shared.

1. Choose which role best describes you:

Choose which role best describes you: Occupational Therapist

Speech Language Pathologist

Physical Therapist

Special Ed Teacher

Other (please specify)

2. Please provide details on your education and training.

Please provide details on your education and training.

3. If you have a private practice, please describe how many patients you treat on a weekly basis and whether you have a clinic and/or do home visits.

If you have a private practice, please describe how many patients you treat on a weekly basis and whether you have a clinic and/or do home visits.

4. Please describe your knowledge and experience with special needs products for children.

Please describe your knowledge and experience with special needs products for children.

5. Do you recommend products to your patients? Please elaborate.

Do you recommend products to your patients? Please elaborate.

6. Where do you go to purchase products for special needs?

Where do you go to purchase products for special needs?

7. What's most important in choosing where you shop? Note: Each ranking can be used only once.

	Most important	Very important	Important	Somewhat Important	Least Important
Quality/Durability	What's most important in choosing where you shop? Note: Each ranking can be used only once. Quality/Durability Most important	Quality/Durability Very important	Quality/Durability Important	Quality/Durability Somewhat Important	Quality/Durability Least Important
Price	Price Most important	Price Very important	Price Important	Price Somewhat Important	Price Least Important
Free Shipping	Free Shipping Most important	Free Shipping Very important	Free Shipping Important	Free Shipping Somewhat Important	Free Shipping Least Important
Variety of Selection	Variety of Selection Most important	Variety of Selection Very important	Variety of Selection Important	Variety of Selection Somewhat Important	Variety of Selection Least Important
Customer Service	Customer Service Most important	Customer Service Very important	Customer Service Important	Customer Service Somewhat Important	Customer Service Least Important

8. Please describe your work experience, including roles and length of service.

Please describe your work experience, including roles and length of service.

9. Please provide details on any direct sales experience that you have.

Please provide details on any direct sales experience that you have.

10. What appeals to you about being a Sales Consultant for Fun and Function?

What appeals to you about being a Sales Consultant for Fun and Function?

11. What questions do you have about the Sales Consultant program?

What questions do you have about the Sales Consultant program?

12. Name a website, blog, magazine or media source that you trust on topics related to children's special needs.

Name a website, blog, magazine or media source that you trust on topics related to children's special needs.

13. Please list any relevant networks or groups that you participate in relating to children's special needs.

Please list any relevant networks or groups that you participate in relating to children's special needs.

14. To be considered for an interview, please provide:

To be considered for an interview, please provide: First Name
Last Name
Email address
Area code and phone
City
State

15. Did you receive this questionnaire from a friend, co-worker, or neighbor? If yes, please provide name of referral.

Did you receive this questionnaire from a friend, co-worker, or neighbor? If yes, please provide name of referral.