Gladiator Short Wrist Orthosis

Name *

Title *

Company Name *

Email *

Phone *

North Coast Account #

1. What do you find most important when selecting a wrist brace? *

Function & QualityPhysician PreferencePrice

2a. What wrist brace length do you prefer: *

Short (1/2 forearm)Long (2/3 forearm)

2b. What wrist brace type do you prefer? *

D-RingWrist-Lacer

3. Does your current wrist brace offer counterforce strapping for a biomechanical advantage? *

No, I wish it didUnsure, I need to checkYes, I think it does

4. What brand of wrist brace do you currently utilize? *

Breg®Hely + Weber® TitanMedSpec®ProCare® Other

5. How many wrist braces on average do you dispense on a monthly basis? *

Less than 1010 - 20More than 20

6. What size & hand would you like for your sample? *

Small LeftSmall RightMedium LeftMedium RightLarge LeftLarge RightExtra Large LeftExtra Large Right

Comments:

Address

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

Samples are intended for healthcare professionals only.