LifeWave X39 Patch Strength Study

1

If you do no qualify, do we have your permission to retain your contact information for future studies?If you do not qualify and do not consent, your information will be deleted/destroyed at the end of this recruitment process.

YESNO

2

Your Privacy Is Important to Us

We want to ensure the data we collect can be verified by researchers and send updates on the study should you qualify to participate. All information recorded will be maintained with the strictest confidentiality except as required by law. For more information, please review our Privacy Policy

3

Name

First Name

Last Name

4

Email

example@example.com

5

Phone Number

Please enter a valid phone number.

6

Postal Code

7

Please Enter Your Date of Birth

Date

8

What is your current height?

Height Number

Height Metric

9

What is your current weight?

Weight Number

Weight Metric

10

What was your assigned sex at birth?

Male

Female

11

Are you presently pregnant, planning to become pregnant or presently breastfeeding?

Yes

No

I can no longer get pregnant.

12

Which type of birth control are you using?

I am no longer able to get pregnant (e.g., menopause (over 12 months), hysterectomy, bilateral oophorectomy, bilaterial tubal ligation, complete endometrial ablation)

Hormonal contraceptives

Double-Barrier method

Intrauterine Device

Non-heterosexual lifestyle

Vasectomy of partner (must have occurred at least 6 months ago)

Abstinence

14

Has your weight been stable over the last 90 days (not have gained or lost more than 5kg of your body weight in the last 3 months)?

YESNO

15

Have you had a history of alcohol or illicit drug abuse, known drug dependence, or are seeking or have sought treatment for alcohol or substance abuse related disorders within the past 12 months?

YESNO

16

Do you regularly drink alcohol?

YESNO

18

Do you use tobacco or nicotine products (e.g., cigarettes, vapes, e-cigarettes)?

I currently smoke.

No, I no longer smoke.

I have never smoked.

19

Do you use cannabis products?

YESNO

20

Reason for Using Cannabis

Prescribed by Health Care Provider

Recreational Use

21

How often do you use recreational cannabis?

Daily or 5-7+ times per week

Regularly or 3-4 times per week

Weekly or 1-2 times per week

Monthly or 1-3 times per month

Occasionally / less than once per month

23

Will you be able to refrain from consuming cannabis before and during the study period?

YESNO

25

If other, please indicate you condition.

26

Did you select kidney issues because you have/had kidney stones?

YESNO

27

Have you been symptoms free for the past 6 months?

YESNO

28

Have you had any significant cardiovascular events in the past 6 months?

YESNO

29

Is your medical condition currently in stable condition (have been treated for at least 3 months with no changes in medications), that is, you are being followed by a physician and taking prescribed medication to control their condition?

YESNO

30

Does you current /past condition affect you ability to preform physical tasks?

YESNO

31

Have you had/been diagnosed with cancer in the past 5 years?

YESNO

32

Was it skin cancer (basal cell carcinoma)?

YESNO

33

Are you currently receiving chemotherapy or radiation treatment?

YESNO

34

Have you had a major surgery in the past 3 months or plan to have surgery in the next 3 months?(including gastric bypass or other weight loss surgeries)

YESNO

35

Do you have or have had a musculoskeletal injury that interferes with you ability to complete physical tasks?

YESNO

36

Do you experience chronic pain (that has lasted 3 months or longer) and required medication to control?

YESNO

39

If other, please list which

41

Are you working on trying to lose weight/gain weight currently?

YESNO

42

Do you have any tattoos?

YESNO

43

If yes, approximately where are they located (i.e., back, neck, arm, around the navel)?

44

Do you have any sensitivities or allergies to adhesives like bandages?

YESNO

45

Do you have any skin conditions?

YESNO

46

If yes, please provide a description of your skin condition.

47

Please indicate which, if any, of the following prescription medications you take:

Anabolic Steriods

Non-Steroidal anti-inflammatories

Hormones (other than birth control)

Narcotics and antispasmodics (e.g. baclofen)

Other

48

Please list Other Medications

49

How long have been on this prescribed medication?

50

Do you use any of the following over-the-counter medications or supplements?

Performance Enhancing Supplements (e.g., creating, caffeine supplements, energy drinks, beta alanine, protein supplements)

Nonsteroidal anti-inflammatory drugs (e.g., acetaminophen)

Topical Muscle Relaxers (e.g., creams, gels or balms containing capsaicin or menthol)

Muscular Therapies: (physical therapy, hot and cold therapy)

51

How long have you been taking them?

Less than 30 days

1-2 Months

3-4 Months

>6 Months

52

Have you been part of a research study before?

YESNO

53

When was the last time you completed (are no longer taking products or being observed for research results) a research study?

1 Month Ago

3-6 Months Ago

More Than 6 Months Ago

54

Do you have any upcoming holiday plans or trips that may alter your regular dietary patterns?

YESNO

56

Please describe where you heard about that study.

57

Please provide contact information for the person who referred you so we can thank them. Name & Email

58

Why did you decide to apply for participation in this study?

Interest in the topic being studied

Compensation being offered for participation

Have participated in clinical trial before.

Other

59

What was the other reason you decided to apply?

60

I consent to receiving communications from KGK Science Inc. and their third-party service providers (via electronic mail, electronic message, telecommunication, and automatic dialing-announcing device including the use of pre-recorded or synthesized voice messages). Your information will not be shared with and/or sold to external companies and is only used for communications with KGK Science.

YESNO