PEMF Response

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PEMF Response

Please Rate your response to your PEMF session. Please answer a survey relative to a joint or other area.

Please score your discomfort at these times:

9-10 Pain++

7-8 Pain+

4-6 Pain

2-3 Annoyance

1 Good

Before

Immediately After

Next Day

Second Day

Fourth Day

One Week

Two Weeks

Clear selection

After therapy, my range of motion was:

3 - Fully Restored

2 - Very Improved

1 - Improved

0 - Same

-1 - Worse

-2 - Much Worse

Other:

Clear selection

What areas(s) did you treat?

Check all that apply

1 - Knee

2 - Ankle

3 - Elbow

4 - Wrist

5 - Low Back

6 - Mid Back

7- Neck

8 - Shoulder

9 - Liver

10 - Abdomen Front

11 - Hip

12 - Head

How many wrap orientations did you use on each joint?

Other:

Clear selection

How many minutes did you treat each area?

More than 5 minutes per area is not recommended

1 Minute

3 Minutes

5 Minutes

9 Minutes

Other:

Clear selection

How long was your total session?

46+ Minutes

31-45 Minutes

21-30 Minutes

11-20 Minutes

5-10 Minutes

4 Min or less

Clear selection

During treatment, each pulse felt:

3 - Strong but Good

2 - Almost Uncomfortable

1 - Felt but No discomfort

0 - Nothing

-1 - Uncomfortable

-2 - Painful

Other:

Clear selection

After therapy I felt:

3 - Energized

2 - Relaxed/Calm

1 - The Same

0 - Tired like I wanted a nap

-1 - Sick

Other:

Clear selection

The night following I slept:

1 - Better than normal

0 - Same as usual

-1 - Worse than usual

Other:

Clear selection

Do you feel you got a lasting benefit from the session?

1 - Yes

2 - Probably

3 - No

Other:

Clear selection

How would you rate your response to PEMF therapy?

3 - Excellent

2 - Good

1 - Okay

0 - None

-1 - Negative

-2 - Very Negative

Clear selection

I used a:

Any other comments?

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