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Better Balance FollowUp Reassessment 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

Your Name: *

Email Address:

Phone Number: *

Question Title

* 2. What Ski Shop Did Your Boot Alignment?


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 Follow Up

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

Other (please specify)

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* 4. What Degree of Canting Adjustments Was Done to Your Boots?

	Fat Side In (FSI)	Fat Side Out (FSO)
Left Boot	Left Boot Fat Side In (FSI) menu	Left Boot Fat Side Out (FSO) menu
Right Boot	Right Boot Fat Side In (FSI) menu	Right Boot Fat Side Out (FSO) menu

Question Title

* 5. Tell Us About Any Other Changes Made to Your Ski Boots?

	Condition	Changed Since Last Session?
Boot Shell	Boot Shell Condition menu	Boot Shell Changed Since Last Session? menu
Boot Liner	Boot Liner Condition menu	Boot Liner Changed Since Last Session? menu
Footbed	Footbed Condition menu	Footbed Changed Since Last Session? menu

Other or Purchasing New (please specify)

Question Title

* 6. Where Did You Purchase Your Ski Boots?

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* 7. Are you currently wearing knee braces or other support devices?


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

* 8. 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

* 9. Tell Us About Your Skis

	Brand Name	Model	Length	Width Under Foot
Pair # !	Pair # ! Brand Name menu	Pair # ! Model menu	Pair # ! Length menu	Pair # ! Width Under Foot menu
Pair # 2	Pair # 2 Brand Name menu	Pair # 2 Model menu	Pair # 2 Length menu	Pair # 2 Width Under Foot menu

Model (please specify)

Question Title

* 10. What Is Your Motivation To Take A Follow Up Session?

	1st Choice	2nd Choice	3rd Choice
I Have Recently Purchased New Equipment And Recognize That Something isn't Right	I Have Recently Purchased New Equipment And Recognize That Something isn't Right 1st Choice	I Have Recently Purchased New Equipment And Recognize That Something isn't Right 2nd Choice	I Have Recently Purchased New Equipment And Recognize That Something isn't Right 3rd Choice
My Equipment is showing it's age and I want to replace it and get it done Properly	My Equipment is showing it's age and I want to replace it and get it done Properly 1st Choice	My Equipment is showing it's age and I want to replace it and get it done Properly 2nd Choice	My Equipment is showing it's age and I want to replace it and get it done Properly 3rd Choice
My Balance has improved but I've Exhausted My Options to Improve it Much Further	My Balance has improved but I've Exhausted My Options to Improve it Much Further 1st Choice	My Balance has improved but I've Exhausted My Options to Improve it Much Further 2nd Choice	My Balance has improved but I've Exhausted My Options to Improve it Much Further 3rd Choice

Any other motivators?

Question Title

* 11. How Did You Hear About The Structural Alignment Screen?

1. Recommended to me by a Friend

2. Recommended to Me by Alpine Pro

3. Recommended to me by Can Ski Blackcomb

4. Recommended to me by SureFoot Whistler

5. Read about the Program on the SST Web Site

Name of Person Who Recommended Us