1. Did you purchase Ideal Feet supports?
2. Yes No
3. Are the products helping you?
4. Yes No
5. Were you satisfied with the store staff?
6. Yes No
7. Did you feel like the staff person was knowledgeable?
8. Yes No
9. Did the staff person explain the wearing instructions?
10. Yes No
11. Name
12. Phone
13. Location of store visited

Date of Visit||

1. What items did you purchase
2. How can we improve
3. Tell us your story