Virtual Reality Therapy Research Evaluation Form
Please provide your feedback and evaluation regarding the VR therapy session.
Participant Full Name
First Name
Last Name
Email Address
example@example.com
Date of Therapy Session
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate your overall experience with the VR therapy session.
1
2
3
4
5
Please describe any improvements or changes you would suggest.
Did you experience any discomfort or side effects?
Option 1
Option 2
Option 3
If yes, please describe the discomfort or side effects.
Submit
Should be Empty: