If you are a patient with a home H-Wave unit it would greatly help us serve you and our other customers by filling out and submitting this customer satisfaction/results survey. It is the goal of Electronic Waveform Lab, Inc. (EWL) to maintain and constantly improve our high levels of success and service, this survey is one way for us to accomplish this. Your time and comments are greatly appreciated.

If you are a medical professional with any comments regarding H-Wave please feel free to contact us. Your comments are greatly appreciated.

Email Address:
Your Full Name:
The serial number from the back of your H-Wave unit:
The name of your EWL/H-Wave representative?
Did your EWL/H-Wave representative inform you on how to contact them?  
Were you instructed thoroughly on the use of the H-Wave by an EWL representative, and do you feel comfortable using the equipment?  
What condition did your doctor prescribe the H-Wave for?
Has H-Wave helped you ________ than prior treatments?  
Have you used any other treatments prior to using H-Wave?

If so, what?
TENS unit
Physical Therapy
Medications
Electrical Stimulation (other than TENS & H-Wave)
Chiropractic
Other
Are you taking any medication (for this condition) at this time or were you taking medication since the time you received your home H-Wave?  
Has H-Wave allowed you to decrease or eliminate the amount of medication taken?  
Has H-Wave allowed you to increase function or perform more activity than you could without it?  
Please describe and give examples (i.e. walking, driving, work, housework, etc.):
Right before the use of H-Wave, please rate the level of pain or loss of function you had experienced.
After using H-Wave what percent of improvement do you receive? (0% - 100%)
How many times do you treat yourself? times per day days a week
How long do you treat yourself?
Are you still seeing the prescribing doctor?
If no, what is the name and telephone number of your new doctor? Doctor
Telephone No.
Patient Comments:
  

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