REFERENCE QUESTIONNAIRE FOR USERS OF CECS

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Family name
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I have used the following CECS-product
CECS-Body
CECS-Technical Devices
CECS-Areas

My trouble is

headache pain in limbs

earache lack of motivation

abdominal pain fall in concentration

pain in soft tissue migraine

backache skin problems

restlessness other problems

other problems

More information

My first contact with CECS-products

My first use of a CECS-Circuit Board-unit

The use of CECS-Circuit Board-units

My personal experience

My personal comment

Would you recommend CECS-technologies ? yes no

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These data are only for internal use.

	headache		pain in limbs
	earache		lack of motivation
	abdominal pain		fall in concentration
	pain in soft tissue		migraine
	backache		skin problems
	restlessness		other problems

My first contact with CECS-products
My first use of a CECS-Circuit Board-unit
The use of CECS-Circuit Board-units