Product Survey Thank you for taking two minutes out of your day! Your answers will help us provide better products and services. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. others? device the Date *First Name *Last Name *Phone Number *Email Address *Which Location Did You Visit *SacramentoPleasant HillOaklandHow satisfied are you with the performance of your device? *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5After using your device for a number of months, please rate your satisfaction with your device on this scale: 5 Stars = Outstanding, 1 = Needs WorkPlease explain how the device has helped you: *What type of device are you wearing?Upper OrthoticLower OrthoticUpper ProstheticLower ProstheticSpinal-CervicalWould your recommend Collier-Laurence to others? *Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 55 Stars = Yes!If you were to list some reasons why you would refer us, what would they be?Would you agree to allow us to share your story? *Yes, I give permission to share my storyNo, please do not share my info publicly.Personal stories are displayed as testimonials on our website here: https://collieroandp.com/patient-care/patient-outcomes. Answers you provide could greatly help others. We are kindly asking your permission to use your feedback in our marketing. By clicking below you are consenting to share information submitted in this form. Your exact wording will be used along with your name. If you choose not to share, your data will only be used internally to improve our services.Submit