SIGVARIS WELL BEING Feedback Form: Web & Response Cards

1. Customer Feedback Form

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Thank you for sharing your opinion on your SIGVARIS garments. Your feedback is important to us and helps us create even better products! This form should take less than 5 minutes to complete. Please note that although we are unable to personally respond to the comments on these surveys, we do read each and every one.

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* 1. Do you give your consent for SIGVARIS to share your feedback within sales or marketing programs? Besides your name, your personal information will not be disclosed [i.e. height, weight, etc.]

Yes, I give my consent.

Yes, I give my consent, but do not share my name and/or job title.

No, I do not give my consent.

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* 2. Please provide your contact information.

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

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* 3. Gender:

Female

Male

Do not wish to disclose

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* 4. Your age group:

20-30 yrs

31-40 yrs

41-50 yrs

51-60 yrs

61-70 yrs

71+ yrs

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* 5. Race/Ethnicity:

White/Caucasian

Asian

Black/African American

Hispanic/Latino

Native American

Pacific Islander

Do not wish to disclose

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* 6. Please enter your weight: [ex. 157 lbs.]

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* 7. Your Height: [ex. 5 feet, 5 inches]

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* 8. What is your Shoe Size?

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* 9. Which SIGVARIS WELL BEING (Or SIGVARIS SPORTS) products are you wearing?

120 Sheer Fashion Hosiery - Knee Hi

120 Sheer Fashion Hosiery - Thigh Hi

120 Sheer Fashion Hosiery - Pantyhose

120 Sheer Fashion Hosiery - Maternity

146/186 Casual Cotton Socks

145/185 Classic Dress Socks

144/184 Athletic Recovery Sock

142/182 Cushioned Cotton Socks

180 Classic Ribbed Socks

189 Business Casual

Other (please specify)

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* 10. Where did you buy these?

Internet dealer

Retail Store

Pharmacy

Other

(please specify)

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* 11. What size was the product you wore?

Don't Know

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* 12. How long have you used graduated compression products?

Less than 1 year

1-3 years

3-5 years

5 years or more

Don't Know

Please tell us how you feel about this product by answering the questions below.

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* 13. Fit:

Very Good

Good

Just Right

Bad

Very Bad

Don't Know

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* 14. Attractiveness:

Very Attractive

Attractive

Okay

Unattractive

Very Unattractive

Don't Know

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* 15. Durability:

Very Durable

Somewhat Durable

Not Very Durable

Don't Know

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* 16. Comfort:

Very Comfortable

Comfortable

Fine

Uncomfortable

Don't Know

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* 1. Do you give your consent for SIGVARIS to share your feedback within sales or marketing programs? Besides your name, your personal information will not be disclosed [i.e. height, weight, etc.]

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* 2. Please provide your contact information.

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* 3. Gender:

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* 4. Your age group:

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* 5. Race/Ethnicity:

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* 6. Please enter your weight: [ex. 157 lbs.]

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* 7. Your Height: [ex. 5 feet, 5 inches]

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* 8. What is your Shoe Size?

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* 9. Which SIGVARIS WELL BEING (Or SIGVARIS SPORTS) products are you wearing?

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* 10. Where did you buy these?

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* 11. What size was the product you wore?

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* 12. How long have you used graduated compression products?

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* 13. Fit:

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* 14. Attractiveness:

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* 15. Durability:

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* 16. Comfort:

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* 17. Would you like to make any additional suggestions or comments?