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| Serial number |
(Last 4 digits of the lot number) |
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Customer Information
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| First Name * | |
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| Last Name * | |
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| Company Name | |
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| E-mail * | |
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| Phone Number | |
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| Address * | |
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| Apt/Suite/Floor | |
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| City * | |
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| ZIP * | |
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| Country * | |
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| State * | |
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| What is your title or position? | |
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About Product
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| Where did you purchase this Tanita Product? | |
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| Where did you hear about us? | |
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| Select facility type: | |
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| Which ONE of the following was the most important factor that influenced your selection of this Tanita product compared to other available products? | |
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| How many patients, per scale, do you weigh on an average day? | |
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| How many scales does your facility have? | |
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| How often do you move your scale (weekly)? | |
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| Do you calculate Body Mass Index (BMI)? | |
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| How satisfied are you with each the following Tanita product attributes? | |
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| Product design | |
| Overall satisfaction | |
| Weight capacity | |
| Features | |
| Ease of use | |
| Accuracy | |
| How likely are you to recommend Tanita to your family and friends? | |
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Internet survey |
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Telephone survey |
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Mail survey |
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Testimonials |
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Tanita body fat / body composition monitors |
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Tanita kitchen scales |
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Tanita hand-held healthcare products |
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Other, specify |
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| Any additional comments or remarks? | |
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| Yes, I'd like to receive periodic information on fitness and health measurement to help me lead a healthier life, as well special offers on healthy lifestyle products from Tanita. |
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