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SHARE YOUR EXPERIENCES !

Every person is “a study”, therefore, collecting as many individual experiences as possible and recording them in our statistics is of utmost importance to us. You will see an example below.

Please tell us your story by submitting a brief summary of your experience in a progress report.

Thank you!

Beispiel Ansehen

Before you share your experiences ...

Please take the time to read and acknowledge the PDF files that can be downloaded here! (Available in English soon)

Information sheet: Participation

Data privacy statement

SUBMIT HERE

First name

Surname

E-Mail adress

Which condition was treated?

Where did/do the symptoms appear?

How long did the treatment last? (Duration of the current therapy cycle) *

Up to one week

Up to two weeks

Up to one month

Up to two months

I treat my symptoms constantly / chronically / occasionally

How long does one treatment last?

Did you notice anything special during the treatment?

Anything else you would like to tell us:

Which device did you use?

Pain level before treatment (before starting the therapy cycle)

1 = no pain5 = biggest imaginable pain

Pain level after the treatment (after the therapy cycle)

1 = no pain5 = biggest imaginable pain

How satisfied are you with the product overall?

What could we improve?

Statistical date *

Male

Female

Other

Age group

Post code (Please add your postcode; it is necessary for the evaluation)

I have read the data privacy statement and the information sheet and would like to make my progress report available.

Thanks for your submission!

We look forward to hearing from you!

Imprint

Privacy

Contact

First name

Surname

E-Mail adress

Phone number

Please leave a message:

I have read and agree with the data privacy statement.

I am a Repuls user

Sent

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