Survey Form

Please take 5 minutes to give us feedback so we can improve our service to you. If you provide your name and contact information at the end of the survey, you will be entered for a chance to win a 3 month supply of Imedeen Time Perfection™ to be awarded in January. Rest assured that your information will not be shared with another company for marketing purposes.

Thanks again for your time and input!

Please mark the answer that best applies to each question.

1. You came to the Imedeen® site today to:

2. How did you get to this website?

Typed in / Other: Please elaborate

3. How many times have you been to this website?

4. How long have you known about Imedeen?

5. How were you introduced to Imedeen?

Other: Please elaborate

6. What does Imedeen mean to you?

7. Did you find everything that you wanted on this website?

Please tell us what you wanted

8. Are Imedeen products available for purchase on this website?

9. Did you buy products from this website today?

Please explain

10. If you bought products today, was it

11. Is there anything you would like to change about this website?

Please describe

12. Are you currently taking Imedeen tablets?

If yes, how long have you been taking Imedeen tablets?

13. How old are you?

Thanks again for your input! We really appreciate it!

If you would like to be included in the drawing for a free 3 month supply of Imedeen Time Perfection, please include your name and contact information below.

Your name:

Email address:

Phone:

The winner will be contacted in January 2006.

Good luck!

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These statements have not been evaluated by the Food & Drug Administration.
These products are not intended to diagnose, treat, cure or prevent any disease.