BalanceWear Survey

1

Please give us a background of your diagnosis and what does it feel like to you.* This field is required.

2

How did you hear about BalanceWear?* This field is required.

3

What was your BalanceWear fitting session like? What was your initial reaction to BalanceWear?* This field is required.

4

How long have you been using BalanceWear and how often do you wear it?* This field is required.

5

How has BalanceWear affected the quality of your life? How has it changed the way you think about your condition and your abilities?* This field is required.

6

What advice would you give to people who are wondering if BalanceWear might be right for them?* This field is required.

7

How likely would you recommend BalanceWear Vest to a friend or colleague?

1
2
3
4
5
6
7
8
9
10

8

Thank you for answering our survey!

On the next page, please fill out your contact information

9

Name* This field is required.

First Name

Last Name

10

Email

example@example.com

11

Phone Number

Please enter a valid phone number.