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* 1. Contact Information

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* 2. Would you like to subscribe to our electronic newsletter, RazNewz?

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* 3. Approval to use info for marketing purposes? eg. customer feedback reviews, testimonials, etc.
(Last name and email will be kept confidential)

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* 4. Position: You are a (Select all that apply)

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* 5. Product: Model Being Used

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* 6. Chair Serial Number:

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* 7. Ratings

  Poor Average Good Excellent
Functionality
Ease of Use
Comfort
Durability
Customization
Aesthetics
Overall Product Quality
Customer Service
Technical Support
Delivery Time
Documentation
Website

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* 8. General Comments

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* 9. What do we do well?

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* 10. What can we do better?

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* 11. Would you recommend Raz to other users and caregivers?

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