Pre SoftWave Therapy Member Survey

3. Have you previously received treatment for this area

• Yes
• No

Which of the following treatments have you tried on the area we will be treating? Select all that apply. *This question is required.

• Dry Needling
• Ultrasound Therapy
• Massage Therapy
• Physical Therapy
• Chiropractic Care
• Cortisone Injection
• Prescriptive Medication
• Over-the-counter Pain Relief
• Surgery
• Acupuncture
• Laser Therapy
• Rest/Ice/Heat Therapy
• Other - Write In Please enter an 'other' value for this selection.

4. In a typical day, which best describes your current level of pain in the area we will be treating? *This question is required.

• Chronic and acute (level 8 and above)
• Chronic and tolerable (Level 4-7)
• Chronic and manageable (Level 1-3)
• Acute but not chronic (Level 8 and above but not constant)

5. How does your pain (in the area we will be treating) affect you in your daily life? Select all that apply. *This question is required.

• No effect. I just live with the pain
• Minimal disruption. Occasionally I refrain from activity that creates the pain.
• Total avoidance. I can no longer do the things I used to do.
• Other - Write In Please enter an 'other' value for this selection.

6. If you feel relief, during or after the SoftWave Treatment, how likely are you to use SoftWave Therapy again if it were offered at the club? *This question is required.

Extremely Likely	Very Likely	Moderately Likely	Slightly Likely	Not Likely
Extremely Likely	Very Likely	Moderately Likely	Slightly Likely	Not Likely