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Name*

First

Last

Address*

Street Address

Address Line 2

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
State

ZIP Code

Phone*Email*

Age*Please enter a number from 1 to 110.Gender*GenderMaleFemaleHeight*format: 5’10″Weight*lbs.Current Athletic Shoe Size*

Which model best describes the wear pattern on your current athletic shoes?

Record a short (10 sec) video of yourself walking on your floor or on a treadmill. Please perform this barefoot and position camera behind you.

File

Select which activities you will be using these shoes for. You can select more than one.

Walking

Running

Gym
How would you classify your running foot strike?HeelMidfootForefootWhich box best descibes your exercise mileage per week.>1010-3030-5050+Any current foot conditions or foot discomfort?

None

Achilles Tendonitis

Athlete’s Foot

Blisters

Bunions

Hammer Toes

Heel Spurs

Metatarsalgia

Plantar Fasciitis

Shin Splints
How much do you usually spend on athletic shoes?>$100$101-$125$126-$150$151+

Which color scheme appeals to you best?

Core

Neutral

Bright

Feminine

Which brand and model do you currently wear?

Adidas

Altra

Asics

Brooks

Hoka

Mizuno

New Balance

Nike

Saucony

On Brand
Other BrandModel?

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