HELP US TO SERVE YOU THE BETTER

Your Name*

First NameLast Name

Your Reachable Email Address*

example@example.com

Your Reachable Whatsapp for Prompt Response*

Please enter a valid whatsapp or skype number.

Shipping to Which Country?*

Where do you know our brand SYREBO?*

The following questions are optional. We would still suggest you finishing filling them, so we could serve you the better! Thanks ^_^

The Patient's Age:

How long have the patient been struggled with a stroke or hand dysfunction?

Which hand of the patient lost the function?

Right handLeft handBoth hands

We have a caregiving group for stroke patients, also inivited a therapist from UK to join, would you love to join and connect with the therapist?*

YesNo

Type your questions here, we would let the internal therapist check if necessary and would respond you ASAP!

Upload the picture or video files of the symptom of the patient's hand