Registration Information 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):
Contact Information
Check one:
Name
If practioner, degree and specialty
Name of clinic or hospital where Alpha-Stim is used
Your Address
Address
City
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State or Province
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Country
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Postal Code
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Day Phone
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Fax
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Email
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Purchased from
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City
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Purchase date
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How did you learn about the Alpha-Stim 100, Alpha-Stim SCS or Alpha-Stim PPM?
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Questionaire 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?
How long have you been using the Alpha-Stim?
How would you rate the results so far? (check one box only):
Would you consider the Alpha-Stim to be (check all that apply)
Comments:
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