Question Title * 1. Contact information Name City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Email Address Phone Number Question Title * 2. How long have you had this bout of tennis elbow pain? Less than 1 month 1 - 3 months 3 - 6 months 6 - 12 months 1 - 3 years 3+ years Other (please specify) Question Title * 3. Have you had surgery for this pain on the involved elbow, wrist or hand? Yes No Question Title * 4. Have you ever had neck pain? Yes No Question Title * 5. If yes, how long ago was your last episode of neck pain? Question Title * 6. Have you ever experienced numbness, tingling or burning in your arm? Yes No Question Title * 7. Rate your elbow pain at its least amount (0-no pain - 10 severe pain) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 8. Rate your elbow pain at its greatest severity (0-no pain - 10 severe pain) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 9. Rate your difficulty opening a jar or turning a doorknob (0-no pain - 10 severe pain) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 10. Rate your difficulty carrying a grocery bag, briefcase / suitcase by the handle (0-no pain - 10 severe pain) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 11. Rate your difficulty with personal activities (cutting, cooking, dressing) (0-no pain - 10 severe pain) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 12. Rate your difficulty performing household/yard work (cleaning, vacuuming, mowing, trimming) (0-no pain - 10 severe pain) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 13. Rate your difficulty with recreational, gym or sporting activities (0-no pain - 10 severe pain) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 14. What do you think you did to create the elbow pain? (Check all that apply) Racket sports (tennis, pickleball, racquetball) Golf DIY (hammer, screwdriver, painting, plumbing) Household chores Weight lifting General exercise Shoveling / raking Carrying something heavy Typing / use of mouse Musical instrument Not sure Other (please specify) Question Title * 15. What is your profession? Manufacturing (assembly line, warehouse, shipping/receiving) Construction (painter, plumber, electrician, road) Graphic Designer Corporate (high computer usage) Musician Other (please specify) Question Title * 16. What solutions have you tried to cure tennis elbow? (Check all that apply) Stop doing activity(s) that caused golfers' elbow Over the counter medications (ibuprofen, acetaminophen, aspirin) Prescription medications (anti-inflammatory, pain medications) Ice/Heat Self massage Elbow sleeve Elbow brace Stretching Percussion device Physical therapy Chiropractor TENS and EMS Acupuncture Diagnostic tests (MRI, X-Ray) Cortisone injection Platelet-Rich Plasma (PRP) Surgery None of the above Other (please specify) Question Title * 17. How have you researched /learned about tennis elbow? (check all that apply) Basic Google / Bing search Medical site research (WebMD, Mayo Clinic) Amazon YouTube Social media Non-medical friend Other (please specify) Question Title * 18. The treatment program consists of using the Fiix Elbow device 10 min/day, 3x/week for 8 weeks. You must also complete simple stretching and strengthening exercises daily. Are you able to commit to this test period and follow the prescribed schedule? Yes No Question Title * 19. You will be asked to complete weekly surveys so we can follow your progress and assist with questions you may have. The surveys are for informational purposes only and your answers will remain private. Can you commit to completing these weekly surveys that take less than 5 minutes? Yes No Question Title * 20. How old are you? Under 18 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65+ Question Title * 21. What is your sex? Male Female Question Title * 22. Is there anything else you would like us to know about your tennis elbow pain? Submit
