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Registration: PBM/COVID-19 Study                                Users of Photobiomodulation & COVID-19
Submit this form to participate in the STUDY. You will receive an Informed Consent Document with information about the study as well as a section for your agreement and signature. Welcome!
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 Full name, First and last,  This personal information will be hidden and only your ID Number used to connect you to your answers.
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 cell phone #,
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Birthdate
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 physical mail address
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How did you learn about this study? (choose all that apply)
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A Web serarch
From a webinar/zoom meeting
From my instructor/therapist
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If someone or some event provided information about this study please let us know.
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Background Information
The following questions help with understanding the effects of Photobiomodulation.
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Do you currently use Photobiomodulation ?
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No, I have not ever used Photobiomodulation devices.
Not now, I did in the past
Yes, daily
Yes, not every day but weekly
Yes, but rarely
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add "Other"
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If yes,  how long have you been using Photobiomodulation (light Therapy)
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1-6 months
7-12 months
1-2 years
2-4 years
4-6 years
more than 7 years
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add "Other"
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If you currently use Photobiomodulation how many sessions  per week?
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0-3
4-6
7-9
10-12
13-15
more than 15
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add "Other"
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How many times per day do you use your light devices?
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Times per day
to
0
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6
Label (optional)
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General overview: 1. What type of device(s) do you use? Check each that apply.
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LED pad system
LED Torches
LED Microlights
LED panel
Full body LED System
Handheld Laser
Handheld LED Device
Other
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add "Other"
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General overview: 1. What type of medications/kind of supplements you are currently taking? Check each that apply.
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Anti inflammatory pain meds/ gabapentin, tumeric
NSAIDS, Asprin, ibuprofen
Vitamin C
Vitamin D
Steroids
Pepcid
Melatonin
Other/ CBD
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add "Other"
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Have you A. tested positive for COVID-19,                        B. experienced symptoms and assumed infected?
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Yes positive and with symptoms
No positive test but had/have symptoms and assumed COVID-19
Yes positive test but without symptoms
No positive test and no symptoms
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add "Other"
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Share below any questions you have, we will contact you to discuss & answer your questions.  Thank you for participating in this project.
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MMD Wellness Group, LLC Contact Info
 Thank you for your feedback. Contact Info: Marcie Denton Principal Investigator study@mmdwellnessgroup.com                               830-377-7936      Mary Wisniewski, Physician Assistant Cell: (616) 443-6982, maryw243@gmail.com
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 Full name, First and last,  This personal information will be hidden and only your ID Number used to connect you to your answers.
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 cell phone #,
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Birthdate
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 physical mail address
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How did you learn about this study? (choose all that apply)
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If someone or some event provided information about this study please let us know.
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No responses yet for this question.
Background Information
Do you currently use Photobiomodulation ?
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No responses yet for this question.
If yes,  how long have you been using Photobiomodulation (light Therapy)
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No responses yet for this question.
If you currently use Photobiomodulation how many sessions  per week?
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No responses yet for this question.
How many times per day do you use your light devices?
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No responses yet for this question.
General overview: 1. What type of device(s) do you use? Check each that apply.
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No responses yet for this question.
General overview: 1. What type of medications/kind of supplements you are currently taking? Check each that apply.
Copy
No responses yet for this question.
Have you A. tested positive for COVID-19,                        B. experienced symptoms and assumed infected?
Copy
No responses yet for this question.
Share below any questions you have, we will contact you to discuss & answer your questions.  Thank you for participating in this project.
Copy
No responses yet for this question.
MMD Wellness Group, LLC Contact Info
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