Question 1 of 8

Do you experience any kind of foot drop or weakness in your leg(s) that makes walking difficult?

This could include conditions like stroke recovery, multiple sclerosis, or other neurological conditions.

Yes No

You're taking the right first step!

Join over 1,000 people who have already improved their walking with EvoWalk.

Question 2 of 8

What condition is contributing to your walking impairment?

Multiple Sclerosis (MS)

Stroke (CVA)

Spinal Cord Injury (SCI)

Traumatic Brain Injury (TBI)

Foot drop due to back surgery or peripheral nerve injury

Other

Question 3 of 8

Ambulation status: Pick the one that best applies to you

I can walk to attend medical appointments without help or rest

I can walk in my house without help

I can walk in my house with a cane or a walker

I cannot walk / I use a wheelchair for most of my mobility

Question 4 of 8

Tell us more about your mobility

What best describes your current walking situation?

I do not currently walk I walk with an assistive device or orthotic I walk without an assistive device or orthotic

Rate your arm function:

Full use of both arms

Full use of one arm

Partial use of both arms

Partial use of one arm only

Do you use a brace on your knee or ankle?

Yes No

Question 5 of 8

Tell us about your healthcare team

Are you under the care of a Physical Medicine and Rehab doctor or Neurologist?

Yes No

Please provide their name

Are you currently working with a Physical Therapist?

Yes, I'm currently working with a PT No Not currently, but willing to work with a PT

Please provide their name or the name of their clinic

Question 6 of 8

A few more questions about your situation

Have you used Functional Electrical Stimulation in the past?

Yes No I'm not sure

Do you live with anyone at home?

Yes No

Question 7 of 8

Please provide your contact information

We'll send you personalized next steps based on your responses.

First Name

Last Name

Email Address

We'll send your assessment results here. Your information is never shared.

Phone Number

By providing your phone number, you agree to receive occasional text messages from Evolution Devices about your assessment or treatment options. Message and data rates may apply. Message frequency varies. You can reply STOP to unsubscribe or HELP for assistance. Your information will never be sold or shared. See our Privacy Policy for more details.

Which state do you live in?

EvoWalk is currently available in the USA only

Final Step

Just a few more quick details

This helps us provide the most relevant information for your situation.

What smartphone do you use?

EvoWalk works with your smartphone to provide walking feedback

Zip Code

How did you hear about EvoWalk?

Would you like a follow-up call?

You can also book a video meeting after completing this form

Questions or additional information? (Optional)

🎉 You're Almost Done!

Click submit to get your personalized assessment results and next steps.

If you've been referred by a healthcare professional, click here

Could EvoWalk Help You Walk Better?

Do you experience any kind of foot drop or weakness in your leg(s) that makes walking difficult?

This could include conditions like stroke recovery, multiple sclerosis, or other neurological conditions.

You're taking the right first step!

What condition is contributing to your walking impairment?

Ambulation status: Pick the one that best applies to you

Tell us more about your mobility

Tell us about your healthcare team

A few more questions about your situation

Please provide your contact information

We'll send you personalized next steps based on your responses.

Just a few more quick details

This helps us provide the most relevant information for your situation.

🎉 You're Almost Done!