MicroCurrent Neurofeedback Survey
24 Hours after each MCN session, we request feedback.
Today's Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
First and Last Name
*
First Name
Last Name
Who facilitated your last MCN Session?
*
Please Select
Coach Resha
Coach Ronny
How many TOTAL MCN sessions have you had including the last one 24 hours ago?
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21 or more
Since your MCN Session, what are you noticing?
*
Rows
Same
Better
Worse
Not Applicable
Sleep
Energy Level
Motivation
Irritability
Daily Bowel Movement
Tinnitus (ringing in ears)
Anxiety
Based on your responses above, please rate each of the following on a scale from 0 to 10. 0 being no improvement to 10 great improvement comparing before MCN to now. Rate each by column.
*
Rows
0 No Improvement
1
2
3
4
5
6
7
8
9
10 Great Improvement
N/A
Sleep
Energy LEevel
Motivation
Irrirtability
Daily Bowel Movement
Tinnitus (ringing in ears)
Anxiety
Please explain or give feedback regarding your responses above.
*
Submit
Should be Empty: