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Frequently Asked Questions: Participants Information
Follow-up Questionnaire

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BioCentric Seminars: Hands-on Follow-up Questionnaire

Name_____________________________________________________Date________________

Address__________________________________________Phone________________________

Employer_________________________________________Phone________________________

Hands-On session: Place ______________________________________Date _______________

IF THE COURSE WAS HELPFUL FOR YOU THIS IS YOUR OPPORTUNITY TO HELP FUTURE PARTICIPANTS by completing this short questionnaire.

Were you helped by the presentation and hands-on session? Yes or No (circle one)

Explain how (if Yes) or why (if No)_________________________________________________

______________________________________________________________________________

Please circle the symptoms for which you have experienced improvement: fatigue, tingling,

numbness, swelling, loss of strength, work pain, night pain, Carpal Tunnel Syndrome.

Please circle the sites involved: back, neck, shoulder, arm, wrist, hand, thumb, fingers.

How soon after the course did you see improvement in symptoms?________________________

Do you have a better attitude toward work now? Yes or No

Please list leisure activities that you could not enjoy before the course, but you can enjoy now:

_____________________________________________________________________________

Is there anything else you would like to tell us about your experience with the BioCentric Technique?

_____________________________________________________________________________

Click here for a printer-friendly version of this follow-up questionnaire.

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