Best prostheses for everyone

1

What is your name?

Please write your first name

2

What is your surname?

Please write your second name

3

What is your active mobile number?

We can reach you through your number

4

Please answer all the questions and leave your email, and we will send you an exclusive invitation to register in our unique platform for empowering individuals with disabilities through advanced technologies.

Please write your email

5

Please select your gender

Choose one answer

Man

Woman

Prefer not answer

Your option

6

Date of Birth?

D/M/Y

7

Where are you from?

Please write your city and country

8

Please choose the amputation option that best aligns with your condition.

Choose one or more answers

9

With the utmost respect and sensitivity, may we inquire about the circumstances that led to the loss of your extremity?

Your response to this question holds significant importance as it aids in understanding causal relationships and, in turn, enables us to take measures to minimize or prevent the occurrence of similar cases in the future. Your input can have a meaningful impact on advancing our knowledge and enhancing the well-being of others.

10

In the context of your initial prosthesis acquisition, if you would be so kind as to share where you obtained it, it would greatly contribute to understanding your journey and assist in providing valuable insights to others in similar circumstances. Your input is sincerely appreciated.

Choose one answer

11

Would you be so kind as to disclose the model or description of your initial prosthesis?

Please write model and manufacturer name

12

Could you kindly enlighten us how did you purchase your FIRST prosthesis?

Choose one or more answers

Covered by health insurance

At the expense of the state

At their own expense

At the expense of a loan

Kind people helped to raise the required amount (crowdfunding)

Please write your option

13

What kind of prosthesis do you have now?

Please write model and manufacturer name

14

You purchased it ...

Please choose one or more answer

At the expense of the state

At their own expenses

At the expense of a loan

Kind people helped to raise the required amount (crowdfunding)

Please write your option

15

At what cost did you purchase your CURRENT prosthesis?

16

How many prostheses have you changed during your life?

17

How often do you change your prostheses?

Выберите один ответ

Every year

Every two years

Every three years

Please write your option

18

When choosing a prosthetic LEG, what is the MOST important?

Arrange in descending order according to your preference (1st is most important, last is least important)

-

A high-quality and correctly manufactured sleeve

-

Knee mechanism

-

Foot mechanism

-

Aesthetics, attractive appearance

-

Price

-

Easily accessible repair parts

-

Weight of prosthesis

19

When choosing a HAND prosthesis, what is the MOST important?

Arrange in descending order according to your preference (1st is most important, last is least important)

-

A high-quality and correctly manufactured sleeve

-

Compression and extension mechanism

-

High-quality pulse sensors

-

Aesthetics, attractive appearance

-

Easily available repair parts

-

Price

-

Weight of the prosthesis

20

What difficulties do you face when buying a prosthesis?

Please choose one or more answers

21

What is your prosthetic center?

Please write name and address of your prosthetic center

22

Have you resorted to Crowdfunding (raising money from those who are not indifferent)

Выберите один ответ

Yes

No

23

Have you ever personally sought help or advice from a professional psychologist or psychotherapist?

Please choose one answer

Yes

No

24

Are you satisfied with your prosthesis now?

Please choose one answer

Yes

No

25

Are you ready to give your old prosthesis to someone in need for free?

Please choose one answer

Yes

No

If not, write please the reason

26

Do you have a job now?

Please choose one answer

Yes

No

If not, write please the reason

27

What are you doing now?

Write your occupation (for example: student, studying programming, artist, seller, etc.)

28

Is there a need in the online store (marketplace) with a large selection of prostheses and components from different manufacturers?

Please choose one answer

Yes

No