Are you a Veteran? *

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I am a Veteran caregiver, family, etc.
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Do you use the My HealtheVet app? *

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Do you primarily use a VA Medical Center or a Community Care Partner? *

VA Medical Center

Community Care

What State is your VA Medical Center *

VA Medical Center Name *

Your VA Physician's name? *

Are you seeking a Migraine Therapy Device? *

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Are you seeking a Virtual Reality Therapy device for trauma, anxiety and PTSD symptoms? *

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Are you seeking Red Light Therapy Device(s) for pain/inflammation? *

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Primary area of pain/inflammation for Red Light Wraps

Ankle

Elbow

Foot

Hand

Knee

Lumbar

Neck

Shoulder

Wrist

SECONDARY area of pain/inflammation for Red Light Wraps

Ankle

Elbow

Foot

Hand

Knee

Lumbar

Neck

Shoulder

Wrist

First Name *

Last Name *

Text # *

Email *

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