Product Registration | Juzo

Product Registration

Thank you for purchasing a Juzo garment and taking time to fill out the information below. The information you provide will be kept strictly confidential and will not be shared with a third party.

Customer Information

First Name:
Last Name:
Address:
Suite:
City:
State:
Zipcode:
Phone:
Email:
Prescribing Physician:
Indication/Diagnosis:
Venous Insufficiency
Lymphedema
Other
Gender:
Male
Female
Age:
25 and Under
26-29
30-39
40-49
50 and Over

Product Information

Where did you obtain your Juzo Garment:
Purchase Date:
Extremity:
Product Model:
Description (Knee High, Thigh High, etc.):
Pairs purchased per year:
Other brands used:
Comments:

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Julius Zorn, Inc. • 3690 Zorn Drive • Cuyahoga Falls, OH 44223 • Call: 1-888-255-1300
Juzo Canada, Ltd. • 1100 Burloak Drive, Ste. 300 • Burlington, ON L7L 6B2 • Call: 1-888-255-1300

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