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Products & Services
Healthcare Providers
Patients
Indication For Use
Here to help
About
Newsroom
Contact
Portal Log-In
Patient Eligibility Survey
If you are a human and are seeing this field, please leave it blank.
First Name
*
Last Name
*
Email
*
Phone
Surgeon's Name
*
Surgeon's Email
*
1. Do you use a mobile phone on a daily-basis other than making phone calls?
Yes
No
N/A
2. How important is your mobile phone in your day to day life?
High Importance
Medium Importance
Little Importance
3. Do you use a mobile phone on a daily-basis other than making phone calls?
Yes
No
N/A
4. How many of the following applications of the mobile phone do you use on a daily basis? Select all that apply.
Calls
Email
Texting
Internet Search
Banking
Health Apps
Social Media
All of the above
None of the above
5. Do you think the use of mobile phones in Medicine is a good thing?
Yes
No
Not sure
6. How important is your security of medical information to you?
High Importance
Medium Importance
Little Importance
7. The private information about your health is protected so that only your doctor or medical professional can have access to your information. Would you allow your doctor access to your information?
Yes
No
Not sure
