Scrambler Therapy Patient Information
The data collected before, during and after treatment with Scrambler Therapy will be de-identified and used for the purposes of Nepean Pain Management’s investigator-lead clinical study.
Email address *
Title: *
Surname: *
Your answer
Given Name(s): *
Your answer
Gender: *
Date of Birth: *
** Depending on your Google Location Settings, the date is either MONTH / DAY / YEAR or DAY / MONTH / YEAR **
MM
/
DD
/
YYYY
Age: *
Your answer
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