Alpha-Stim

Alpha-Stim

Select Your Language

Espanol Francais
Italiano Korean
Chinese Nederlands
Turkish Norwegian
Australian
Latvian Sweden
Israel

EPI

2201 Garrett Morris Parkway
Mineral Wells, TX 76067-9034
USA
1-800-FOR-PAIN (367-7246)
in USA & CANADA
Tel: (940) 328-0788
Fax: (940) 328-0888
Email

© Copyright 2010 Electromedical Products International, Inc.
All rights reserved.

Alpha-Stim® is registered in the US Patent and Trademark office and worldwide.

SGS AIS AwardSBCAwego U.S. Chamber of Commerce Member 2008
Celebrating 29 Years 1981-2010

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 only one)



Serial number

Contact Information
Check one

Name
If practitioner, degree and speciality
Name of clinic or hospital where Alpha-Stim® is used
Address
City
State
Country
Postal Code
Phone
Fax
Email
Purchased From
Purchased City
Purchase date
How did you learn about the Alpha-Stim® 100,Alpha-Stim® SCS or Alpha-Stim® PPM?

Questionairre
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?

How long have you been using the Alpha-Stim® technology?
How would you rate the results so far?
(check one box only):






Would you consider Alpha-Stim® technology to be
(check all that apply)