MicroCurrent Neurofeedback Survey
24 Hours after each MCN session, we request feedback.
Today's Date
-
Month
-
Day
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?
*
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.
*
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: