Name________________________________
Address_______________________ City_______________St._____ Zip__________
Phone_________________ Email__________________________________________
Are you a recreational skier___ a ski instructor___ a ski patrol or a racer___?
How many years have you skied?____
What is the average number of days you ski per year?____
Where do you ski most of the time?____________________________
Approximately how many days will you ski this season?____
Do you ski wild___ fast___ moderate___ slow___ cautious___ or race___?
How much of the day do you ski in the bumps? ____%
Do you ski the trees___ or off trail___ park or pipe___?
What sports have you or are you involved in?____________________________
Do you have or have had foot, ankle, leg or knee problems?_______________
Do you get cold feet/hands?_____
What are the three important things you want when you purchase new boots?
1___________________ 2____________________ 3_______________________
When you purchase new boots would you like a
Recreational fit___ Performance fit___ or Race fit___?
Boots I would like to consider are.___________________________
What are you interested in, Front entry___Mid entry___or Custom boots___?
What price range would you like, from $______to $______or Un-Decided___?
What is the reason you are purchasing new boots?________________________
What problems do you have with your present boots?______________________
What make is your present boots and the size?__________________ _____
Do you wear ORTHOTICS in shoes ____ or ski boots ____?
Are you planning to purchase Boots___Skis___Bindings___Poles___?
Are you interested in A CUSTOM SKI BOOT ORTHOTIC? ____
Boot Warmers___ Wedging___ Balancing___ or Clothing___?
