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Customer Testimonial Form
First name
Email
Birthday
Month
Day
Year
Multi choice
Option 1Name (optional): ______________________________
Age: ______
Type of travel:
□ Cruise
□ Boat trip
□ Fishing charter
□ RV / car travel
□ Air travel
How bad was your motion sickness before trying ANMSS?
0 (none) – 10 (severe): _______
Did the ear drops help you during travel?
□ Yes
□ Somewhat
□ No
What changes did you notice?
________________________________________
Would you recommend ANMSS to others?
Optional short quote we may use:
Permission to use this testimonial in marketing:
Signature (optional): ___________________________
Option 2
Short answer
Long answer
Number
File upload
Upload File
Star rating
Submit
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