Exit this survey >> SIGVARIS WELL BEING Feedback Form: Web & Response Cards 1. Customer Feedback Form Question Title 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. Question Title * 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. Question Title * 2. Please provide your contact information. Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code: Country: Email Address: Phone Number: Question Title * 3. Gender: Female Male Do not wish to disclose Question Title * 4. Your age group: 20-30 yrs 31-40 yrs 41-50 yrs 51-60 yrs 61-70 yrs 71+ yrs Question Title * 5. Race/Ethnicity: White/Caucasian Asian Black/African American Hispanic/Latino Native American Pacific Islander Do not wish to disclose Question Title * 6. Please enter your weight: [ex. 157 lbs.] Question Title * 7. Your Height: [ex. 5 feet, 5 inches] Question Title * 8. What is your Shoe Size? 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 Question Title * 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) Question Title * 10. Where did you buy these? Internet dealer Retail Store Pharmacy Other (please specify) Question Title * 11. What size was the product you wore? A B C D E F Don't Know Question Title * 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. Question Title * 13. Fit: Very Good Good Just Right Bad Very Bad Don't Know Question Title * 14. Attractiveness: Very Attractive Attractive Okay Unattractive Very Unattractive Don't Know Question Title * 15. Durability: Very Durable Somewhat Durable Not Very Durable Don't Know Question Title * 16. Comfort: Very Comfortable Comfortable Fine Uncomfortable Don't Know Question Title * 17. Would you like to make any additional suggestions or comments? Next >>