Menopause Capsule Feedback Form

Menopause Capsule Feedback Form

Thank you for trying our product. Your feedback is valuable to us. This survey will take 10 minutes to complete. Your information will be kept confidential.
1. About you

Tell us more about yourself
1.1. Name*
1.2. Email*
1.3. Mobile Number

Country CodePhone Number
1.4. Age*
1.5. City and country of residence*
2. Before you used this product

Tell us about your condition
2.1. At what age did you start experiencing menopause symptom(s)?*

2.2. How serious are the symptom(s)? On a scale of 1 to 5 where 1 is 'not serious' and 5 is 'very serious'. Please tick below. Please tick below.*

	5 very serious	4	3	2	1 not serious	N/A
Hot flushes
Night sweats
Anxiety
Fatigue
Sleep disorder

2.2_oth. Other symptoms (if any)
*Hot flushes*
A sudden and intense feelings of warmth over the face and upper body, accompanied by a rapid heartbeat, perspiration and weakness.

*Night sweats*
Repeated episodes of extreme perspiration that may occasionally disrupt your sleep

*Anxiety*
A feeling of nervousness, restlessness and tension.

*Fatigue*
A feeling of constant tiredness or weakness.

*Insomnia*
Hard to fall asleep, stay asleep, or wake up too early and not able to get back to sleep.
2.3. Have you consulted a doctor about your menopause condition?*

YesNo
2.3a. Did the doctor give you any medication or supplement?*

YesNo
2.3a_yes. What medication did the doctor give?*
2.3b. Are they effective and do you still use them?*

Yes, they are effective and I am still using themYes, they are effective but I stopped using themNo, they are not effective and I stopped using them
2.3c. Why did you stop using even though they are effective?*
2.4. Have you tried other menopause treatments?*

YesNo
2.4a_yes. What treatment(s) have you tried?*
2.4b. Are they effective and do you still use them?*

Yes, they are effective and I am still using themYes, they are effective but I stopped using themNo, they are not effective and I stopped using them
2.4c. Why did you stop using even though they are effective?*
3. After you used this product

Tell us whether the menopause capsules helped
3.1. How long have you used the menopause capsules? *
3.2. How many capsules did you take daily?*

2 capsules, 2 times dailyOther, please specify:
3.3. Did you experience an improvement in your symptoms?*

YesNo
3.3a. When did you see this improvement?*

Within 3 daysWithin 1 weekWithin 3 weeksWithin 4 weeks
3.3b. How much overall improvement did you experience on scale of 1 (very small improvement) to 5 (very big improvement).*

1 - Very small improvement2345 - Very big improvement

3.3c_oth. Other symptoms (if any)
*Hot flushes*
A sudden and intense feelings of warmth over the face and upper body, accompanied by a rapid heartbeat, perspiration and weakness.

*Night sweats*
Repeated episodes of extreme perspiration that may occasionally disrupt your sleep

*Anxiety*
A feeling of nervousness, restlessness and tension.

*Fatigue*
A feeling of constant tiredness or weakness.

*Insomnia*
Hard to fall asleep, stay asleep, or wake up too early and not able to get back to sleep.
Product Pricing

Now we would like you to think about Amelior's pricing
P1. At what price would you say Amelior is GOOD VALUE FOR MONEY?
*insert price in dollars & cents
P2. At what price would you say Amelior is EXPENSIVE BUT WORTH CONSIDERING?
*insert price in dollars & cents
*P2 Price should be higher than P1. GOOD FOR VALUE price. Kindly revise the price.
P3. At what price would you say Amelior is TOO EXPENSIVE TO CONSIDER?
*insert price in dollars & cents
*P3 price should be higher than P2. TOO EXPENSIVE TO CONSIDER price. Kindly revise the price.
P4. At what price would you say Amelior is TOO CHEAP TO BE OF VALUE?
*insert price in dollars & cents
*P4 price should be lower than P1. GOOD VALUE FOR MONEY price. Please revise the price.
4. How do you feel about this product?

Tell us what you think about the menopause capsule
4.1. How do you rate overall performance?*

PoorFairGoodVery goodExcellent
4.2. Will you recommend to family and friends?*

Definitely notProbably notSomewhat likelyProbably yesDefinitely yes
4.3. How likely are you to purchase again?*

Definitely notProbably notSomewhat likelyProbably yesDefinitely yes
4.4. Do you agree that this product is better than other menopause products*

Completely disagreeDisagreeSomewhat agreeAgreeStrongly agree
4.5 Please rank the importance when looking out for a menopause supplement? Drag and drop the item from rank 1 (most important) to 6 (least important).*
4.6. Please share with us how you feel after using this product, and how we can improve.*
Thank You!

This is the end of the survey. Thank you.
Please tick if you allow us to use your information and feedback for marketing purpose.

Yes, you may use my feedback and only my initials for marketing purposes.Yes, you may contact me for more information.
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Menopause Capsule Feedback Form

1. About you

2. Before you used this product

3. After you used this product

Product Pricing

4. How do you feel about this product?

Thank You!