PillGlide Questionnaire
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1. PillGlide Review
We are interested in your feedback about our new product PillGlide. Please complete the following survey. This information will help us improve our product to meet our customers needs. Thank you in advance for your participation!
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1
. Which of the following are or have been barriers when swallowing tablets and capsules?
Which of the following are or have been barriers when swallowing tablets and capsules?
Size
Taste
Smell
Texture
Shape
The number of capsules/tablets
I have no problem swallowing pills
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2
. Did Pill Glide help you take your tablets and capsules?
Did Pill Glide help you take your tablets and capsules?
Yes
No
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3
. What flavor of Pill Glide did you sample?
What flavor of Pill Glide did you sample?
Grape
Peach
Orange
Strawberry
Bubblegum
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4
. Did you like the taste?
Did you like the taste?
Yes
No
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5
. How many pumps of the spray worked best for you?
How many pumps of the spray worked best for you?
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6
. Would you use Pill Glide again?
Would you use Pill Glide again?
Yes
No
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7
. What would you pay for this product?
What would you pay for this product?
8
. What is the gender of the person using the product?
What is the gender of the person using the product?
Male
Female
9
. Please provide the year of birth for the person using this product.
Please provide the year of birth for the person using this product.
10
. Please provide any additional feedback or comments you wish to share.
Please provide any additional feedback or comments you wish to share.
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11
. Can we publish your comments?
Can we publish your comments?
Yes
No
If yes, please provide your Name, City and State
12
. Please provide the pharmacy name where you received your PillGlide sample if applicable:
Please provide the pharmacy name where you received your PillGlide sample if applicable:
13
. If you would like additional information on our products, please include your information below:
If you would like additional information on our products, please include your information below:
Name:
Address:
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State:
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Email Address:
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