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First and Last Name:
Address:
City:
State
Zip:
Email:
Telephone:
Based on your submissions you may qualify for additional specials or discounts What is the best time to contact you if you qualify?
How
tall are you?
User 1: User 2:
What is your weight?
User 1: User 2:
How would you rate your physical condition,
1 = poor, 10 = excellent
User 1:
User 2:
What is most important
to you in a massage chair?
Describe what you think
the perfect massage chair could do for you?
What areas of your
body would you say needs the most massage attention on a regular
basis?
How often, if ever,
do you see a massage therapist or chiropractor?
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?
What
did you like the most about this massage chair?
What did this chair not do for you?
What will be the primary use of this chair?
What is your interest or need level for a massage chair (1 - 10)
1 = I'm just curious
10 = I believe this is necessary for me