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Active Arm Online Feedback
RequiredRequired Question(s)
1.

Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Email Address:
emailaddress@xyz.com
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

What is your age range?
18 - 25
26 - 35
36 - 45
46 - 55
55+
Required 3.


What injury led to your purchase?
Tennis Elbow
Shoulder Strain
Shoulder Impingement
Golfer's Elbow
Wrist Strain or Tendonitis
Carpal Tunnel
Neck/Shoulder Strain
Other  
Required 4.


What other prior treatments have you tried to relieve your pain?
Over-the-counter remedies
Braces or Straps
Physical therapy
Prescription Drugs
Surgery
Required 5.


Where did the injury occur?
Sport Activity
Work
Other  
Required 6.

Have you changed or stopped an activity because of your injury?
YES
NO
Required 7.

How did you first hear about the ActiveArm program?
Friend
Family
Coworker
Internet Advertisement
Internet Search
Other  
Required 8.


Please rate from 1 (Best) to 5 (Worst) the:
 1 = Superior 2 = Excellent 3 = Good 2 = Poor 1 = Inferior 
Quality of the exercise bands
Quality of the packaging
Ease of purchase
DVD Instructional Video
  • Comment:

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9.


Comments?  Questions?  We value your input.
 

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