Hook Splint

Name *

Company Name *

North Coast Account #

Title *

Email *

Phone *

Check or list the name of your preferred distributor: *

North Coast MedicalPerformance HealthMedlineMeyerPTAdvantage MedicalPT UnitedOther

Prior to seeing this ad for Hook Splint, were you familiar with the term Relative Motion Orthosis or RMO? *

Yes, very familiarYes, somewhat familiarNo, not familiar

Share with us your thoughts on the retail pricing on the Hook Splint ($30.00) *

Too expensiveJust about rightToo inexpensive

Other Distributor

Does the fact that the Hook Splint was invented by a Certified Hand Therapist in collaboration with a Hand Surgeon provide you with added confidence? *

Yes, very much soSure, it’s appreciated and importantNo, not important at all

What size sample would you prefer to receive? *

Small/MediumLargeX-Large

Mailing Address *

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

Samples are intended for healthcare professionals only.

Hook Splint Free Sample Form

Verification

Hand Therapy

Physical Therapy

Occupational Therapy

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