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Contact Information
First Name
Last Name
Address
Phone
Email Address
DOB
How old are you?
Do you have your current knee pain more than 3 months?
Yes
No
How long have you had the current knee pain? (months, years)
Do you have activity-related pain? (e.g., pain during walking, ascending/descending stairs, or any activities)
Yes
No
Do you have knee
morning stiffness
lasting more than 30 minutes?
No
Yes
In the past week, how would you rate your average knee pain on a 0-10 scale where 0 means no pain and 10 means the maximum level of pain you can imagine?
Knee pain intensity (0-10)
Do you have pain at other body locations?
Yes
No
If yes, is your knee pain still the main issue?
Yes
No
NA
Can you read and understand English?
Yes
No
Do you currently have any of the following conditions? If none, check NA
Any skin issues, injuries, or diseases of the left ear
History of cardiac rhythm disturbances/abnormalities
History of vagotomy
Recurrent vagal syncope
Use of other medical devices electrically active (e.g., pacemaker)
Severe and/or uncontrolled diseases
(e.g., cardiovascular, pulmonary, neurological diseases, malignant diseases)
Pregnant or breastfeeding
Numbness, sensation loss, regular use of cast/splint, open skin wounds on wrists, knees, and forearms
Any intervention procedures initiated for knee pain in the past 3 months? (other than medications)
(e.g., physical therapy)
NA
If you recently initiated interventional procedures (other then medications), what type of treatments is it? If you do not have any ongoing interventional procedures, write N/A
What is the best way to contact you?
Text
Email
Phone
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