Did you purchase the product for personal use (for yourself or your family)?
  Yes    No

Did you purchase the product as a school representative?
  Yes    No

       If yes, please tell us the school you represent:
      

Did you purchase the product for resale?
  Yes    No

       If yes, please let us know the organization:
      

Gender of the person(s) using the product?
  Male    Female

Age range of the person(s) using the product?
  Under 14
  14 to 18
  19 to 25
  26 to 35
  36 to 45
  46 to 55
  56 to 65
  66 plus

Product category:   Neck/Head   Hands, Wrist, Elbows, Arms   Waist, Back, Shoulder, Chest   Knees, Thigh, Groin   Feet, Ankle, Shins   Sprays, Gels, Hot/Cold Items   Tapes, Wraps   Other

Lot Number: Reference Number/Part Number: Size:   SM    MD    LG    XL   XXS   XS     XXL   XXXL    XXXXL   OSFM   Reg   Sm/Md   Lg/Xl   Yth        Yth-Reg  Yth-Lg    Not Applicable

Please tell us the date you purchased the product:
  Month:  MM 01 02 03 04 05 06 07 08 09 10 11 12      Year:

Approximately how often have you used this product?
  2-3 times a week
  Once a week
  2-3 times a month
  Once a month
  Less than once a month

What is the primary activity that this product is used with?
  Work    Chores around home     While sleeping  Relaxing at home  Athletic activities

What, if any, medical condition/concern was this product used to treat?

How likely are you to purchase a Mueller product again?
  Very likely    Somewhat likely     Neutral  Somewhat unlikely  Very unlikely
 

Please rank the reason you purchased a Mueller product:

Please rate each of the categories for the product on the following qualities:

Do you have a suggestion to change or improve the product?  Yes  No

     If yes, please comment:
    


Is there a product you would like Mueller to carry?  Yes  No

     If yes, please comment:
    

Are there other comments or suggestions you would like to make about Mueller Sports Medicine products?

At Mueller Sports Medicine, we value your privacy.  We will not resell or redistribute your personal information without your permission.