Before using Menstrual Magic®:
During your cycle do you experience menstrual cramps?
Yes No

How often/how many days?

How severe were your cramps? 1 Mild 2 3 4 5 Medium 6 7 8 9 10 Severe

Did you take the recommended number of Menstrual Magic® softgels according to your discomfort level at the first sigh of cramps?
Yes No

After using Menstrual Magic®:
How long did it take for cramps to subside?

Did the cramps reoccur?
Yes No

If yes, how long after the dose?

How severe were these cramps? 1 Mild 2 3 4 5 Medium 6 7 8 9 10 Severe

Did you experience any relief from:
Nausea
Bloating
MoodSwings
Other (describe)

Did you experience any side effects?
Yes No

If yes, please explain:

How many days did you use Menstrual Magic®?

What was the total number of softgels used?

How would you evaluate your experience with Menstrual Magic®?
Excellent Good Fair Poor

Would you recommend Menstrual Magic® 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: