1
About your visit
How did you hear about us?
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Previous customer
Social Media
TV
Newspaper
Website
Friend
Medical referral
Walk by a shop
Other
Which store did you visit?
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Albany
Dunedin
Hamilton
Invercargill
Lower Hutt
Masterton
Napier
Nelson
New Plymouth
Newmarket
Northlands
Online
Palmerston North
Ponsonby
Porirua
Riccarton
Taupo
Wellington
2
Your experience
During your visit, did the team:
Measure your feet
Choose an option
Yes
No
I chose not to
Not applicable
Offer treadmill video analysis
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Yes
No
I chose not to
Not applicable
Update your Advantage Club points
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Yes
No
I chose not to
Not applicable
3
Additional comments
4
Your details
Fill this in if you would like to be contacted by Shoe Clinic.
Name
Email
Phone
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