Invacare 9805 Owners Manual - Page 5

PRODUCT REGISTRATION FORM Register ONLINE at www.invacare.com - or Complete and mail this form Name Address City State/Province __________ Zip/Postal Code ________ Email Phone No Fold here Invacare Model No Serial No Purchased From Date of Purchase Cut Along Line 1. Method of purchase: (check all that apply) ❏ Medicare ❏ Insurance ❏ Medicaid ❏ Other 2. This product was purchased for use by: (check one) ❏ Self ❏ Parent ❏ Spouse ❏ Other 3. Product was purchased for use at: ❏ Home ❏ Facility ❏ Other 4. I purchased an Invacare product because: ❏ Price ❏ Features (list features 5. Who referred you to Invacare products? (check all that apply) ❏ Doctor ❏ Therapist ❏ Friend ❏ Relative ❏ Dealer/Provider ❏ Other_________ ❏ Advertisement (circle one): TV, Radio, Magazine, Newspaper ❏ No Referral_____ 6. What additional features, if any, would you like to see on this product? Fold 7. Would you like information sent to you about Invacare products that may be available for a here particular medical condition? ❏ Yes ❏ No If yes, please list any condition(s) here and we will send you information by email and/or mail about any available Invacare products that may help treat, care for or manage such condition(s 8. Would you like to receive updated information via email or regular mail about the Invacare home medical products sold by Invacare's dealers? ❏ Yes ❏ No 9. What would you like to see on the Invacare website 10. Would you like to be part of future online surveys for Invacare products? ❏ Yes ❏ No 11. User's Year of birth If at any time you wish not to receive future mailings from us, please contact us at Invacare Corporation, CRM Department, 39400 Taylor Parkway, Elyria, OH 44035, or fax to 877-619-7996 and we will remove you from our mailing list. To find more information about our products, visit www.invacare.com. Part No 1024492 5 Portable Patient Lift and Sling