SkinStim Clinical Registry Survey Form

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* 1. Are you satisfied with the results of your SkinStim Treatment?

Yes

No

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* 2. Did you notice reduction of facial wrinkles?

Yes

No

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* 3. Did you notice reduction of eye area wrinkles?

Yes

No

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* 4. Did you notice reduction of neck wrinkles?

Yes

No

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* 5. Did your collagen content increase?

Yes

No

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* 6. Did you skin inflammation reduce?

Yes

No

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* 7. Did your skin elasticity increase?

Yes

No

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* 8. Would you recommend the SkinStim TM therapy to a friend?

Yes

No