OrthoThermic Gloves

Name *

Title *

Company Name *

Email *

Phone *

North Coast Account #

1. Do you currently recommend or dispense thermal gloves to patients? *

YesNo

2. If yes, what brand name do your currently recommend or dispense?

Thermoskin®SwedoOther

3. If you find the OrthoThermic™ Gloves to be superior in quality and value as compared to Thermoskin® or Swedo, will you switch to OrthoThermic™? *

YesNo

4. What is your monthly usage of thermal glove pairs: *

Less than 55 - 1010 or more

5. What are you paying for thermal glove pairs? *

More than $30Between $20 - $30Less than $20

6. Would you order a full finger version of OrthoThermic™ if it were available? *

YesNo

Address *

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

Thermoskin® is a registered trademark of United Pacific Industries Pty Ltd. Samples are intended for healthcare professionals only.