FlexGel Hand Exerciser

Name *

Company Name *

North Coast Account # *

Title *

Email *

Phone *

What hand exercisers do you currently purchase? *

Eggsercizer® Hand ExerciserTheraBand® Hand ExerciserCanDo® Hand Exercise BallOther

Are you satisfied with your current hand exercisers? *

YesNo

If you find the Rainbow™ FlexGel™ Hand Exerciser to be superior in quality and price, as compared to what you are currently using, will you switch to Rainbow™ FlexGel™ Hand Exerciser? *

YesNo

Other Hand Exerciser:

If you find the quality and price of the Rainbow® FlexGel Hand Exerciser acceptable, estimate your clinics monthly usage, estimate your clinics monthly usage: *

1- 56 - 10More than 10

Select your Rainbow™ FlexGel™ Hand Exerciser sample resistance level: *

Level 1 - X-SoftLevel 2 - SoftLevel 3 - MediumLevel 4 - FirmLevel 5 - X-Firm

Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Samples are intended for healthcare professionals only.

Rainbow™ FlexGel™ Hand Exerciser Sample Request Form

Verification

Hand Therapy

Physical Therapy

Occupational Therapy

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