Application 2 Survey

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Application 2 Market Survey

NAME OF SPONSOR COMPANY: PeriphEX Corp.

STUDY ADMINISTRATOR: Disruptive Engagement

We hope that you enjoyed your second NoxyPure application. Please answer the survey questions below. Thank you.

Name*
First Last
Did you take your last treatment?
- Yes
- No
How many days ago was your last treatment?
Have you noticed a change in your pain after your second treatment?
Strong Releif Moderate Relief Some Relief No Relief More pain
If you have relief after treatment, how long does the relief last?
Please describe the relief that you have felt
i.e. less aches and pains, less numbness, more feeling, more active, ability to not focus on pain
How convient was it to take the treatment?
Very convenient Somewhat convenient Convenient Somewhat inconvenient Very Inconvenient
Was the treatment disruptive to your daily routine?
Not at all disruptive A little disruptive Neither Somewhat disruptive Very disruptive
What did you do during your treatment?
Please describe the relief that you have felt
Did you have to carve out time in your schedule to take the treatment?
Is there anything else you would like to share?