OrthoThermic Thumb CMC

Name *

Title *

Company Name *

Email *

Phone *

North Coast Account #

1. Does your clinic or practice submit for insurance billing for CMC Restriction Orthotics? *

YesNo

2. Name the brand of CMC orthotic you have had the most success with: *

Comfort Cool®Push MetaGrip Other

3. Are you, your practice and your patients satisfied with the current CMC Orthotic being utilized? *

Yes, very satisfied, no complaintsYes, somewhat satisfied with a few complaintsNo, not satisfied, open to exploring better options

4. In your opinion, Is providing additional warmth in a CMC orthotic an advantage? *

Yes, most definitelyYes, I think soNo, unsure of any benefit

5. What size sample would you prefer: *

SmallSmall +MediumMedium +LargeLarge +X-Large

Mailing Address *

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

Samples are intended for healthcare professionals only.