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Three Jagged Colors

Questionnaire for

NeuroCes™ PWL-05 Cranial Electrotherapy Stimulator

Form No: QNC N2102, Version: 1.2.0

Gender
Female
Male
Age
Under 20 years old
20 – 30 year old
31 – 40 year old
41 – 50 year old
51 – 60 year old
Over 60 years old
How long have you been using NeuroCes™?
1 – 30 days
1 – 3 mount
3 – 6 mount
6 – 12 mount
More than 12 months
How would you rate the results of NeuroCes™ PWL-05 Cranial Electrotherapy Stimulator so far?
Worse (Negative Change)
No Change (0%)
Slight improvement (1 to 24%)
Fair Improvement (25 to 49%)
Moderate Improvement (50 to 74%)
Marked Improvement (75 to 99%)
Complete Recovery (100%)
Would you consider NeuroCes™ PWL-05 Cranial Electrotherapy Stimulator safe to use?
No Report
Yes
No
Would you consider NeuroCes™ PWL-05 Cranial Electrotherapy Stimulator effective?
Yes
No
NeuroCes™ PWL-05 Cranial Electrotherapy Stimulator is more effective than anything else I have used for my:
Have you experienced adverse effect such as;
Do you think that the design of device needs to be changed?
Yes
No
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