Natural Miracles Inc.

			Natural Miracles Inc.
			Makers of all-natural products based on pharmaceutical grade essential oils





		INFLAMAGIC® Confidential Survey This voluntary survey is intended to help us improve the formulation and effectiveness of INFLAMAGIC®. Information from this survey wil be kept strictly confidential. Before taking INFLAMAGIC®: Describe the nature of your health condition: How long have you had the condition? How often/how many days? How severe? Did you take one softgel of INFLAMAGIC® at the first sign of occurance? Yes No After taking INFLAMAGIC®: Did the condition improve? Yes No How much improvement occurred? How long did it take to improve? Did the condition re-occur? Yes No If yes, how long after the dose? How severe was the re-occurrance? Did you take additional dose(s)? Yes No What was the total number of softgels used? How many days did you use INFLAMAGIC®? Did you experience any side effects? Yes No If yes, please explain: How would you evaluate your experience with INFLAMAGIC®? Would you recommend INFLAMAGIC® to others? Yes No Would you purchase this product in the future? Yes No Testimonial (please give a brief description of your experience): Name: Address: City: State: Zip: E-Mail Address: Date of Birth: