Survey Feedback

This page is for those individuals participating in our double-blind Clinical Study. We are trying to get feedback about the effectiveness of AlgalAid vs other cold sore treatments. You may be eligible to participate in the study. If you participate, we will send you a free tube of AlgalAid.

Instructions

First, thank you for participating in our study!

Please answer all questions.
If you are not sure how to answer a question, contact us.
Refer to the Five Stages of a Cold Sore to help answer questions.
Please use the comments area to list whatever you feel may have influenced your (hopefully rapid) recovery.
Upon receipt of this form, we will send you a free sample of AlgalAid and discard
your contact information.

Clinical Study Feedback

Your Name(required)
What type of sample did you receive?
"X" sample "Y" sample
What was the Lot # for your sample?(required)
At which cold sore stage was your sample applied?(required)
If applied at the prodromal stage, did it prevent the outbreak?(required)
On what date did you first notice the cold sore?(required)
Approximately what time did you first notice the cold sore? (required)
On what date was it healed? (required)
Approximately what time was it healed? (required)
How often do you suffer from cold sores? (required)
What is your age (in years)?(required)
What is your gender?
Male Female
How would you describe your skin pigmentation?
1 light
2
3
4
5 dark
Which ethnicity best describes you?(required)
Comments Please include any additional herbs or remedies taken, side effects or your general impression of AlgalAid(required)

Human Verification

What color is a red balloon?

cforms contact form by delicious:days

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