Comfort Questionnaire | The Back Store | sleep well. we've got your back

Client Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Contact Phone

Home Phone Cell Phone

Contact Email*

Purchase Details

Your Receipt/Order No.*

Date of Purchase*

Date of Delivery

*Note: Required 30 night minimum must be met prior to submitting form.

Brand of Mattress Purchased*

Type of Base I Purchased*

Other Details

Since I got my new mattress, my primary sleeping position is:*

On my old mattress, my primary sleeping position was:*

My old mattress was:*

I would describe the comfort level of my new mattress as:*

I sleep:*

Partner details:

I am having difficulty getting used to my new mattress, but my sleep partner seems to be enjoying it.
I enjoy my mattress, but my sleep partner is having difficulty getting used to it.
Both of us are struggling to adjust to our new mattress.

I would describe the difficulty I'm having with my new mattress as:*

If you purchased an adjustable foundation how frequently are you using and describe primary use:

I would describe my sleep quality on my new mattress as:*

List any alternative mattress options consided before purchase:

Additional Comments:

I have read & understand the guidelines of The Back Store's Comfort Tryout & Return Policy. I have also met the 30 day minimum requirement prior to submitting this form.