Detailed Enquiry
Make the most out of your precious recovery time by sending us a detailed enquiry.This form allows the NeuroAiD™ product specialists to better understand your specific case (or your dear one's) in order to give you an appropriate answer.NeuroAiD™'s well trained and dedicated staff will get back to you within one business day. All particulars remain strictly confidential. |
| (Please note that fields with * are mandatory) |
STROKE DETAILS
| When did the stroke occur?* |
| Who did suffer from a stroke?* | Myself | A dear one |
| Patient's Age: |
| What type of stroke was it? | Ischemic | Hemorrhagic |
| What disabilities did it cause ? |
| Hemiplegia | Visual Loss |
| Aphasia (speech loss) | Memory Loss | |||
| Sensory Loss of one side of the body | ||||
| How much is the patient independent? |
REHABILITATION
| Is it still ongoing? | Yes | No |
| Duration | Less than 3 months | Between 3 and 6 months |
| Between 6 and 12 months | More than a year |
| Intensity: | Less than once per week | Once to twice per week |
| Three to five times per week | Everyday |
GENERAL INFORMATION
| First Name *: | Last Name *: | ||
| Email *: | Confirm Email *: |
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| Telephone number *: | Country *: |
| What questions do you have about NeuroAiD™? |
| (Before submitting your enquiry, please note that your doctor is in the best position to advise you on the ideal treatment for your individual situation. In case of doubt, always seek advice from your doctor) |
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