Request edit access
BioBack Experience Evaluation Form
Thank you for sharing information regarding your experience(s) with the BioBack. Your feedback will help us to continue our efforts to deliver a superior product in order to provide pain relief and help improve the quality of life for low back pain sufferers. Please rate your experience with the BioBack no sooner than after having tried the BioBack at least three times over the course of at least one week.
Email address *
Your name? *
Age
Gender *
Are you currently suffering from or experiencing back pain *
On a scale of 1 (no pain) to 10 (extreme pain) rate your back pain when present: *
No Pain
Extreme and Constant Pain
How long have you had back pain?
Does your back pain limit you from performing any activity or activities
Did the BioBack fit you perfectly right out of the package? *
If not, did the instructions / information provided clearly explain how to resize / fit the BioBack? *
Did the instructions / information provided clearly explain how to apply, wear and use the BioBack? *
Rate your experience with BioBack for following: *
1. No Benefit
2. Some Benefit
3. Moderate Benefit
4. Good Benefit
5. Incredible Benefit / Relief / Comfort
6. Not Applicable
Pain Relief
Improved Mobility (able to resume an activity)
Improved Posture
Reduced Need for Pain Medication
Pain Prevention
Comfort
How often did you wear the BioBack? *
Required
If you continued to use BioBack, on average how long did you wear the BioBack per use? *
Rate your overall experience with the BioBack *
Poor (No or limited benefit)
Excellent (Incredible Benefit or Relief)
Would you recommend the BioBack to others? *
What do you think is an appropriate Retail Price (what would you be willing to pay) for the BioBack? *
Comment(s) or Testimonial Regarding BioBack Use:
If you provided comments or a testimonial, may we have your permission to reproduce or publicly use your first name and last initial with your evaluation feedback? *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy