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Name
Age of cane user
Are you the primary user of the cane?
Yes No
Was the cane
If other please explain.
How did you find out about the Raising Cane®?
What is your primary cane, and why?
If you own a Raising Cane® please rate your satisfaction level with the cane (5 being the best)
Would you recommend our cane to others?
Yes No
Why?
What changes, if any, would you like to see made to the Raising Cane®?
How many other canes do you currently own or have previously used?
Raising Cane® users:
Why did you choose the Raising Cane®?
Are their situations where you substitute an alternative cane for the Raising Cane®? If yes, When do you use the other cane and for what situations?
Would you like a representative from Raising Canes to contact you?
Yes No
If yes......
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