First Name:*
Last Name :*
Address:
Email:*
Telephone:*
How
tall are you? User 1: *
Choose One
Under 5ft
5-ft. 1-in.
5-ft. 2-in.
5-ft. 3-in.
5-ft. 4-in.
5-ft. 5-in.
5-ft. 6-in.
5-ft. 7-in.
5-ft. 8-in.
5-ft. 9-in.
5-ft. 10-in.
5-ft. 11-in.
6-ft
6-ft. 1-in.
6-ft. 2-in.
6-ft. 3-in.
6-ft. 4-in.
6-ft. 5-in.
Over 6-ft. 5-in
User 2:
Choose One
Under 5ft
5-ft. 1-in.
5-ft. 2-in.
5-ft. 3-in.
5-ft. 4-in.
5-ft. 5-in.
5-ft. 6-in.
5-ft. 7-in.
5-ft. 8-in.
5-ft. 9-in.
5-ft. 10-in.
5-ft. 11-in.
6-ft
6-ft. 1-in.
6-ft. 2-in.
6-ft. 3-in.
6-ft. 4-in.
6-ft. 5-in.
Over 6-ft. 5-in
What is your weight? User 1:*
Choose One
less than 80
80-100
100-120
120-150
150-180
180-210
210-240
240-270
270-300
over 300
User 2:
Choose One
less than 80
80-100
100-120
120-150
150-180
180-210
210-240
240-270
270-300
over 300
How would you rate your physical condition,
User 1:*
Choose One
1
2
3
4
5
6
7
8
9
10
Choose One
1
2
3
4
5
6
7
8
9
10
What is most important
to you in a massage chair? *
Choose One
Strength of massage
Fit
Durability
Warranty
Bells and whistles
Price
Looks
Describe what you think
the perfect massage chair would do for you?*
What areas of your
body would you say needs the most massage attention on a regular
basis?
Choose One
Neck
Shoulders
Mid Back
Lower Back
Seat and Thighs
Calves
Feet
How often, if ever,
do you see a massage therapist or chiropractor?
Choose One
once a week
twice a month
once a month
Once a year
twice a year
Never
Do you or the
other user(s) have any medical issues or injuries which the massage
chair would be used to help, if so please describe.
Have
you tried a massage chair before, if so, which one?
Choose One
Panasonic
Premier Health
ijoy
Interactive
Inada
Human Touch
Osim
Other
Ive never tried one
Where
did you try this massage chair?
Choose One
Brookstone
Sharper Image
Relax The Back
Vending chair in the
mall
Another store
What
did you like the most about this massage chair?
What did this chair not do for you?
What is your price range?*
Would you like to receive a free reprint of the Consumer's Digest magazine massage therapy products review and a fee massage chair DVD?
