Survey Form – The Charleston Bending Brace

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For Parents
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About

How It Works
For Clinicians
For Parents
Evidence
About

Survey Form

As the owner and president of The Charleston Bending Brace, I want to thank you for ordering one of our bending braces. In the interest of providing the best quality possible and to better understand your neechs, we kindly ask that you complete the following survey.

Thank you for your continued support.

Sincerely,
C. Ralph Hooper, Jr., CPO

Name

Company

Type of Brace

CBB-Standard Bi-Valve CBB-Lite

Please rate overall quality of brace received on a scale of 1-5 (1 being least satisfactory and 5 being most satisfactory)

Overall fit of the brace..

1 2 3 4 5

Length of brace (not too short or too long)

1 2 3 4 5

Strap placement and wear

1 2 3 4 5

Trim Lines

1 2 3 4 5

Initial Impression of (Single Pull) Brace

1 2 3 4 5

Effectiveness of Lumbar Pad (If Applicable)

1 2 3 4 5

Additional Comments (Optional)

Email