Patient Survey

Share your feedback after using your Altivera device.

Which doctor prescribed the device for you?*

Which device was prescribed to you?

Patient First Name*

Patient Last Name*

Date of Birth*

What area(s) of the body are you treating?*

How many days per week do you use your device?*

What is your pain rating before using the device? (10 being the worst pain and 1 being no pain)

What is your pain rating after using the device? (10 being the worst pain and 1 being no pain)

Since using the device, have you reduced your usage of medication including pain killers, muscle relaxants, etc.?

On a scale of 1-10, how much have your symptoms been reduced? (10 being the best 1 being the worst)

Comments

We're Hiring

Join our growing team and help patients across the country. Visit our careers page to learn more about open positions.