Product Registration Product ID # Name Address City State Zip Code Country Phone E-mail Address Date of Purchase 1. Product Type: UE-AG   UE-CG   Glove   LE-AB   LE-AD   LE-AF   LE-AI   Vest   Head   FGU   THU   BR   2. Who may we thank for recommending Tribute products to you? Therapist or Fitter's Name Business Name City / State 3. How long have you had lymphedema? Less than 1 Year   6-10 Years   21-30 Years   2-5 Years   11-20 Years   31-40 Years   4. What other lymphedema treatment products have you used? Multi-layered Bandages   Compression Garments   Vasopneumatic Pump   Circ-Aid Medical Products   Med-Assist Sleeve   Reid Sleeve   Jovi-Pak   Unna Boot    Other:   5. Would you be willing to participate in a 2-year follow-up study? Yes   No   Contact me to tell me more   6. Which protocal have you been instructed to follow? Wear nightly alone Wear nightly under bandages Wear nightly with outer jacket Wear day and night under bandages Use with compression pump