Welcome to Research Partner Program Follow Up Survey

Thank you for participating in our Research Partner Program! Your data will be used to document TheraTogs efficacy. Please feel out this survey within 90 days of first issuing the TheraTogs system to your patient. If you have any questions, please contact us at 866-410-8062 or support@gaitways.com. 

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* 2. Address

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* 3. Patient Age (years and months)

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* 5. Patient Diagnosis:

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* 7. Primary TheraTogs Objective:

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* 8. Charted Improvements (include any evidence):

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* 9. Recent Scores or standard Functional Assessment tests (GMFM-88, GMFM-66, PEDI, AIM, etc.):

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* 10. Please choose the items that best describe the patient's response to TheraTogs:

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