IntiMax Sample Feedback Report
Participant Information:
Name:
Age:
Gender:
Contact Information:
Product Information:
Sample Type (Male/Female):
Date of Sample Received:
Flavour:
Dosage:
Duration of Use:
Feedback Questions:
Ease of Use (Scale 1-5):
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Comments:
Taste (Scale 1-5):
Did you notice any improvement in your libido or energy levels? (Yes/No):
If yes, please describe the changes:
On a scale of 1-5 how effective was the product?
Did you experience any side effects? (Yes/No):
If yes, please describe the side effects:
How severe were the side effects? (Scale 1-5):
Overall, how satisfied are you with the product? (Scale 1-5):
Would you recommend this product to others? (Yes/No):
Additional Feedback:
Consent:
By participating in this trial I agree to provide honest feedback about the product and understand that my personal information will be kept confidential and used only for the purposes of this trial.
Participant Signature:
Date:
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