BodStim TM by Wiemspro Post Market Clinical Evaluation Registry Study - KLOTHO LEVELS

Customer Client User RESEARCH Satisfaction Survey

Question Title

* 1. Your overall satisfaction with BodStim?

Disappointed.

Mildly satisfied.

Fairly satisfied.

Very satisfied.

Extremely enthusiastic satisfied.

Disappointed.

Mildly satisfied.

Fairly satisfied.

Very satisfied.

Extremely enthusiastic satisfied.

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* 2. Was the suit comfortable?

Yes

Other (please specify)

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* 3. Was the software easy to use?

Very difficult needs to be improved.

Mildly difficult at first but eventually got it.

Fairly easy to use but could use some improvements.

Easy to use after training period.

Very intuitive easy to use.

Very difficult needs to be improved.

Mildly difficult at first but eventually got it.

Fairly easy to use but could use some improvements.

Easy to use after training period.

Very intuitive easy to use.

Question Title

* 4. After 12 weeks of use 2X a week I noticed these results

Exercise capacity at baseline ie; how many pull-ups or push-ups or time on treadmill

Exercise capacity at 12 weeks ie; how many pull-ups or push-ups or time on treadmill

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* 5. My circulating klohto levels

Klotho level at baseline

Klotho level at 12 weeks

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* 6. Contact Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 7. Date

Date / Time

Date