Care Cream Feedback Form

Care Cream 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 Do you have any chronic skin conditions, such as acne and eczema?*

YesNo
2.1a Which of the following skin conditions do you have (please tick one or more)*

AcneContact dermatitisEczemaHivesPsoriasisOther, please specify
*Acne*
Breakouts composed of blackheads, whiteheads, pimples.

* Contact dermatitis *
Rash appears where your skin touched the irritating substance.

*Eczema*
Red, itchy rashes outbreaks.

* Hives *
Itchy, raised welts that are red, pink, or flesh-colored, and sometimes sting or hurt.

* Psoriasis *
Scaly, silvery, sharply defined skin patches on scalp, elbow, knees, or lower back.

2.1b_oth. Other symptoms (if any)
2.2. Have you consulted a doctor about your skin condition?*

YesNo
2.2a. Did the doctor give you any medication or supplement?*

YesNo
2.2a_yes. What medication did the doctor give?*
2.2b. 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
2.2c. Why did you stop using even though they are effective?*
2.3. Have you tried other treatments?*

YesNo
2.3a_yes. What treatment(s) have you tried?*
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?*
3. After you used this product

Tell us whether the care cream helped
3.1. How long have you used the care cream?*
3.2. How many times did you apply daily?*

1 time daily2 times daily3 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 2 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)
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 care cream
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 better than other cream products?*

Completely disagreeDisagreeSomewhat agreeAgreeStrongly agree
4.5 Please rank the importance when looking out for skin treatment? 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.
Should be Empty:

	5 very serious	4	3	2	1 not serious	N/A
Acne
Contact dermatitis
Eczema
Hives
Psoriasis

	5 very serious	4	3	2	1 not serious	N/A
Acne
Contact dermatitis
Eczema
Hives
Psoriasis

Care Cream 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!