How did you hear about us? Newspaper (which one) Magazine (which one) Yellow Pages Google Ad □ □ □ □ ___________________ __________________ Physician (Dr.?) □ Other website (which one) Our website did you download our FREE Heel Plan Book? Yes No □ □ – □ □ ______________________ Would you like a copy? Yes No □ □ Family/Friend (name?) _______________________ Other ________________________ □ □
How did you hear about us? □ Newspaper (which one) □ Magazine (which one) □ Yellow Pages □ Google Ad ___________________ __________________ □ Physician (Dr.?) □ Other website (which one) □ Our website – did you download our FREE Heel Plan Book? □ Yes □ No ______________________ Would you like a copy? □ Yes □ No □ Family/Friend (name?) _______________________ □ Other ________________________
tfc-patient-history-form.docx