Register your product to insure warranty coverage under EPI’s 5 Year Limited Warranty (Previously Owned Quality Assured Alpha-Stim‘s receive a 1 Year Limited Warranty).
Check type of unit (check one only):
Alpha-Stim 100 microcurrent & cranial electrotherapy stimulator
practioner purchasing for practice patient purchasing for self
If practioner, degree and specialty
Name of clinic or hospital where Alpha-Stim is used
State or Province
How did you learn about the Alpha-Stim 100, Alpha-Stim SCS or Alpha-Stim PPM?
The following optional, voluntary information would be appreciated and will help in our ongoing research. Please fill in after 30 days of use.
What is your diagnosis?
What is your age?
Sex: M F
How long have you been using the Alpha-Stim?
Have you: completed Treatment still using it discontinued it because
How would you rate the results so far? (check one box only):
Worse (negative change)
Would you consider the Alpha-Stim to be (check all that apply)