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Why Alpha-Stim?
How It Works
Testimonials
FAQs
Research
How It’s Used
Treating Anxiety
Treating Insomnia
Treating Depression
Treating Pain
Alpha-Stim Device
Alpha-Stim AID
Alpha-Stim M
Get Started
Accessories
Mobile App
Healthcare Professionals
Prescribing Alpha-Stim
Webinars
Tutorials
Forms
Resources
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Videos
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Why Alpha-Stim?
How Alpha-Stim® Works
FAQs
Testimonials
Research
How It’s Used
Treating Anxiety
Treating Insomnia
Treating Depression
Treating Pain
Alpha-Stim Device
Alpha-Stim M
Alpha-Stim AID
Accessories
Mobile App
Healthcare Professionals
Prescribing Alpha-Stim
Webinars
Forms
Tutorials
Resources
Blog
Videos
Guides
Shop
Get Started
Menu
Why Alpha-Stim?
How Alpha-Stim® Works
FAQs
Testimonials
Research
How It’s Used
Treating Anxiety
Treating Insomnia
Treating Depression
Treating Pain
Alpha-Stim Device
Alpha-Stim M
Alpha-Stim AID
Accessories
Mobile App
Healthcare Professionals
Prescribing Alpha-Stim
Webinars
Forms
Tutorials
Resources
Blog
Videos
Guides
Shop
Get Started
Sales Refund Request or Loan Return Survey
See Below for the Sales Refund Request / Loan Return Survey
We’d like you to get the most from your Alpha-Stim. Most issues can be resolved with the assistance of our customer support, clinical support, or your local Alpha-Stim representative. If you’d like some more time with your Alpha-Stim while we assist you in the reason for your return, please contact us immediately at info@epii.com or by calling 1-800-FOR-PAIN instead of submitting this form.
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*
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*
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Email
*
Phone
*
Date
*
MM slash DD slash YYYY
EPI staff you've been working with
EPI account number
Type of request
Sales refund – 30 day guarantee
Practitioner loan return
Device model
*
Alpha-Stim M
Alpha-Stim AID
Device serial number
*
Device was purchased for
Yourself
Medical practice
Relative or friend
If device was a loan, what type?
Evaluation for practice
Evaluation for patient
Research
Government
How long did you use Alpha-Stim?
What was being treated?
*
Anxiety
Insomnia
Pain
Other
If other, specify:
What was the most important thing to you in deciding to buy/trial the Alpha-Stim?
Previous treatment did not work
Drug side effects
Heard or read about Alpha-Stim
Other
If other, please specify:
What is the reason for returning your Alpha-Stim?
*
Problem resolved
Insurance didn’t cover
Too costly
Side effects (please specify below)
Did not get the results I was looking for
Considering another device (please specify below)
Other (please specify below)
Please specify:
Did you seek help from our free clinical support team?
Yes
No
If so, do you have any comments regarding our free clinical support?
Is there information that you could not find or was not provided that would have been more helpful in resolving your problem with the Alpha-Stim?
What might we have done differently to help you?
Do you have any other comments that you would like to make?
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