Vigo 90-day trial sign up form

We kindly ask you to fill in this form for our specialists to evaluate if Vigo is best suited for your condition and needs.

Please leave your contact information and answer the short questionnaire. If you're filling the form on behalf of someone with that condition, please note that below.

After submitting the form, our specialists will soon get back to you.

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Question Title

* 1. Contact info

Name, surname

Stroke survivor/relative/other

E-mail

Mobile

Question Title

* 2. Is the stroke survivor age 18 or above?

Yes

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* 3. Please specify the English language skills of the stroke survivor!

Native speaker

Second language

Third language

The stroke survivor doesn't speak English

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* 4. Has the stroke survivor suffered a stroke or a head injury?

Yes, stroke

Yes, head injury

None of the above

Both of the above

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* 5. What stroke-caused impairments is the survivor recovering from? (Multiple answers are available)

Weakness on one side of the body (hemiparesis)

Impaired balance

Impaired fine motor skills (finger movement)

Reduced motivation for any activities

Depressive tendencies (mood swings, sadness etc.)

Anxiety (if there was none before)

Other (please specify)

None of the above

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* 6. Would the stroke survivor have access to an Apple iPad and internet connection during recovery?

Yes

None of the two are available

No, there is no Apple iPad available

No, there is no internet access

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* 7. Can the stroke survivor read and understand a simple written text in English?

Yes

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* 8. Besides the digital skills, is the stroke survivor able to use an iPad?

Yes, independently

Yes, with some help

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* 9. Is the stroke survivor able to do physical exercises?

Yes, independently

Yes, with some help

No, not at all

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* 10. Is the stroke survivor experiencing any of the following?

Psychiatric illness or co-morbidity (permanent)

Alcohol or drug addiction

None of the above

Other