Pain Pre-Study Survey
Fill out this survey as best you can so that we can get an accurate reading of how you feel before the study begins
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Email *
Who invited you to participate in the study? *
Name (First, Last) *
Age *
Phone Number *
Preferred mode of contact (to keep in touch and pass on information) *
Required
What is your home address (For mailing the samples if necessary)
*
How often do you feel pain in your body? *
What type (s) of pain do you experience? (ex: headache, joint pain, nerve pain, etc.) *
Required
How intense is your pain when it occurs? *
Low
High
How long has this been a problem *
Are you willing to stick to the protocol and give honest feedback? The study requires you use the products consistently throughout the week for optimal results. Are you willing to do so? *
Have you watched the Pre-Study Orientation? Are you willing to view the results video (10min) at the end of the Study? (Required to receive incentive gifts) *
Please enter below, the code given during the overview:
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