PedRx Feedback Form
Please provide feedback on why PedRx is not right for you
Account Number
Account Name
Rep Name
Please Select
Bob Armbruster
Brad Clary
Bruce Cannon
Cindy Larris
Denise Day
Gary Ehrlich
Jeff Larris
Jim Sheridan
Kyla Greenfield
Michele Baker
Paul Vazquez
Customer Type
Please Select
Medical Distributor
Medical Equipment
Medical Ortho & Prosthetics
Medical Pharmacy
Medical Podiatry
What is Propet's "Brand Rank" within your Store?
What is your current account volume
What is your current return rate?
Is the interest primarily in purchasing A5500 shoes or Cash Sales?
Please Select
Yes
No
Is the issue related to dissatisfaction with the service provided?
Please Select
Yes
No
Services Provided: shoe horn, free shipping, left/right shoe audit
If Yes, please elaborate on issue(s)
Is the decision primarily driven by price concerns?
Please Select
Yes
No
If yes, please elaborate
What is the average cost of items purchase?
List Specific items currently being purchased
What are the reimbursement challenges being faced?
Medicaid reimbursement
HMO reimbursement
Lower private insurance reimbursement
Other
If 'Other,' please specify reimbursement challenges
If 'Other,' please specify reimbursement challenges
Are your concerns related to previous deals with Propét or competitive offers?
Please Select
Previous Deals
Competitors
Both
If you’ve chosen a competitor, would you be willing to share their offer with us?”
Please Select
Yes
No
What additional features or programs would appeal to you?
Additional Notes or Observations
Submit
Should be Empty: