Better Balance Skier Profile

1. Default Section

Any Questions with an asterisk * requires at least one answer in order to complete the survey.

Question Title

1. Please Provide (Required.)

Your Name: *

Email Address:

Phone Number: *

Question Title

2. Do You Have A Preference in Ski Shops? (Required.)


Alpine Pro	Alpine Pro menu
Can Ski Blackcomb	Can Ski Blackcomb menu
SureFoot Whistler	SureFoot Whistler menu

Question Title

3. Please Choose Your Preferred Time To Do Your Screening (Required.)

	Month	Day
Date & Time	Date & Time Month menu	Date & Time Day menu

Other (please specify)

Question Title

4. What is Your Running Shoe Size and Your Ski Boot Size? (Required.)

	Shoe Size	Ski Boot Size [Mondo]
Shoe + Boot Size	Shoe + Boot Size Shoe Size menu	Shoe + Boot Size Ski Boot Size [Mondo] menu

Other (please specify)

Question Title

5. Tell Us About Your Ski Boots? (Required.)

	Condition
Boot Shell	Boot Shell Condition menu
Boot Liner	Boot Liner Condition menu
Footbed	Footbed Condition menu

Other or Purchasing New (please specify)

Question Title

6. Where Did You Purchase Your Ski Boots?

Question Title

7. What Level of Skier Are You?

Entry Level (skied 2 seasons or less, still skid my turns)

Intermediate Level ( skied less than 5 seasons, can grip but not carve my turns)

Advanced Level ( skied more than 5 seasons, can carve my turns on most of the time)

Expert Level ( skied many seasons, can carve my turns)

Other (please specify)

Question Title

8. Are you currently wearing knee braces or other support devices? (Required.)


Left Knee Brace/Support	Left Knee Brace/Support menu
Right Knee Brace/Support	Right Knee Brace/Support menu
Mojo's	Mojo's menu

Other (please specify)

Question Title

9. Have you had a hip or knee replacement? (Required.)


Left Hip	Left Hip menu
Right Hip	Right Hip menu
Left Knee	Left Knee menu
Right Knee	Right Knee menu

Other (please specify)

Question Title

10. Have You Ever Had Your Alignment Corrected?

	Knock Kneed	Bow Legged	Fore/Aft
Yes Left Boot Side	Yes Left Boot Side Knock Kneed menu	Yes Left Boot Side Bow Legged menu	Yes Left Boot Side Fore/Aft menu
Yes Right Boot Side	Yes Right Boot Side Knock Kneed menu	Yes Right Boot Side Bow Legged menu	Yes Right Boot Side Fore/Aft menu
No	No Knock Kneed menu	No Bow Legged menu	No Fore/Aft menu

Other (please specify)

Question Title

11. What Is Your Motivation To Take The Screening? (Required.)

	1st Choice	2nd Choice	3rd Choice
I Have Recently Purchased New Equipment But Recognize That Something is Still Wrong	I Have Recently Purchased New Equipment But Recognize That Something is Still Wrong 1st Choice	I Have Recently Purchased New Equipment But Recognize That Something is Still Wrong 2nd Choice	I Have Recently Purchased New Equipment But Recognize That Something is Still Wrong 3rd Choice
My Equipment is showing it's age and I want to replace it and get it done right	My Equipment is showing it's age and I want to replace it and get it done right 1st Choice	My Equipment is showing it's age and I want to replace it and get it done right 2nd Choice	My Equipment is showing it's age and I want to replace it and get it done right 3rd Choice
I suspect that there is something structurally misaligned in my legs/feet and want it corrected	I suspect that there is something structurally misaligned in my legs/feet and want it corrected 1st Choice	I suspect that there is something structurally misaligned in my legs/feet and want it corrected 2nd Choice	I suspect that there is something structurally misaligned in my legs/feet and want it corrected 3rd Choice

Any other motivators?

Question Title

12. How Did You Hear About The Structural Alignment Screen? (Required.)

1. Recommended to me by a friend

2. Recommended to me by Can Ski Blackcomb

3. Recommended to me by SureFoot Whistler

4. Read about the program on the SST Web Site

Other (please specify)

Question Title

* 1. Please Provide (Required.)

Question Title

* 2. Do You Have A Preference in Ski Shops? (Required.)

Question Title

* 3. Please Choose Your Preferred Time To Do Your Screening (Required.)

Question Title

* 4. What is Your Running Shoe Size and Your Ski Boot Size? (Required.)

Question Title

* 5. Tell Us About Your Ski Boots? (Required.)

Question Title

* 6. Where Did You Purchase Your Ski Boots?

Question Title

* 7. What Level of Skier Are You?

Question Title

* 8. Are you currently wearing knee braces or other support devices? (Required.)

Question Title

* 9. Have you had a hip or knee replacement? (Required.)

Question Title

* 10. Have You Ever Had Your Alignment Corrected?

Question Title

* 11. What Is Your Motivation To Take The Screening? (Required.)

Question Title

* 12. How Did You Hear About The Structural Alignment Screen? (Required.)

1. Please Provide (Required.)

2. Do You Have A Preference in Ski Shops? (Required.)

3. Please Choose Your Preferred Time To Do Your Screening (Required.)

4. What is Your Running Shoe Size and Your Ski Boot Size? (Required.)

5. Tell Us About Your Ski Boots? (Required.)

6. Where Did You Purchase Your Ski Boots?

7. What Level of Skier Are You?

8. Are you currently wearing knee braces or other support devices? (Required.)

9. Have you had a hip or knee replacement? (Required.)

10. Have You Ever Had Your Alignment Corrected?

11. What Is Your Motivation To Take The Screening? (Required.)

12. How Did You Hear About The Structural Alignment Screen? (Required.)