patient survey

Question Title

* 1. Name of survey Taker

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* 2. What kind of pain do you experience?

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* 3. Years experiencing pain

0-5

5-10

10+

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* 4. Have you used the 10-point pain scale and how effective was it at expressing your pain?

very effective

somewhat effective

not effective

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* 5. Have you been prescribed a pain diary before and what was your experience with it?

yes, it was helpful

yes, but it was not helpful

no, but patients have kept a personal journal

no, i have never prescribed a pain diary

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* 6. Would you be interested in participating in a short interview to discuss your perspectives on pain assessment and our product? (include contact info if so)

Yes

No

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* 7. contact email or phone number

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* 8. 1. Do you understand the concept of the XTech Tracker by Xpressive tech?

Yes

No

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* 9. 1. Do you understand the concept of the XTech Tracker by Xpressive tech?

Yes

No