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Miracle Ear
1
ARE YOU INTERESTED IN THIS REVOLUTIONARY, VIRTUALLY INVISIBLE HEARING AID FOR YOURSELF OR A LOVED ONE?
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FOR MYSELF
FOR A LOVED ONE
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2
ARE YOU 50 YEARS OR OLDER?
YES
NO
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3
Unfortunately,
based on your answers, you do not fit the profile we are looking for at the moment.
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4
WHAT IS YOUR GENDER
Male
Female
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5
DO YOU SOMETIMES HAVE TROUBLE UNDERSTANDING SPEECH IN NOISY SITUATIONS?
YES
NO
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6
CONGRATULATIONS!!
You qualified to try this revolutionary, virtually invisible hearing aid for FREE!
Full Name
Surname
Email
City
Address
Postal Code
Phone Number
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7
IS YOUR LOVED ONE 50 YEARS OR OLDER?
YES
NO
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8
IS YOUR LOVED ONE MALE OR FEMALE?
Male
Female
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9
DOES YOUR LOVED ONE SOMETIMES HAVE TROUBLE UNDERSTANDING YOU IN NOISY ENVIRONMENTS?
YES
NO
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