Consumer Feedback Form Immune Ice form February 2021. Please fill in this form 7 Immune Ltd Consumer Feedback Form Full Name : Age Full Address : Contact Telephone : Email Address : Gender : Gender : Male Female Other Would you recommend Immune Ice to other people? Would you recommend Immune Ice to other people? Yes No How long have you been taking Immune Ice? How long have you been taking Immune Ice?1-3 Months3-6 Months6-9 Months9-12 Months1 Year + Would you say while taking Immune Ice has a positive change in your mood, health and fitness? Would you say while taking Immune Ice has a positive change in your mood, health and fitness? Extremely Very Moderately Slightly Not at al Do you suffer from an illness? Do you suffer from an illness? Yes No If Yes, what illness do you suffer from? (If No, type none.) Has Immune Ice helped you with your illness? Has Immune Ice helped you with your illness? Yes No If yes, How would you describe this improvement? Do you take Immune Ice alongside any medication? Do you take Immune Ice alongside any medication? Yes No If yes, what medication do you take? Have you noticed improvements in your energy levels, on a scale of 0 to 10? (if no change please select 1) Have you noticed improvements in your energy levels, on a scale of 0 to 10? (if no change please select 1) 1 2 3 4 5 6 7 8 9 10 Do you suffer from headaches? Do you suffer from headaches? Yes No If you have headaches would you take Immune Ice instead of taking tablets? If you have headaches would you take Immune Ice instead of taking tablets? Yes No Have you noticed any improvements in your headaches while taking Immune Ice? Please describe these improvements. Do you suffer from lack of sleep? Do you suffer from lack of sleep? Yes No If yes, has Immune Ice helped you get a good nights sleep? If yes, has Immune Ice helped you get a good nights sleep? Yes No Do you suffer from inflammation? Do you suffer from inflammation? Yes No If yes, have you noticed any reduction in inflammation when taking Immune Ice? Please describe below. Has your body shown signs of having a stronger immune after taking Immune Ice? Has your body shown signs of having a stronger immune after taking Immune Ice? Yes No 4 + 9 = Submit Thank you for taking part!