WELCOME TO THE DEEP HEAT INFLUENCER PROJECT- fill in the survey below!

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* 1. Personal Information

Full Name:

City:

Email Address:

Contact Number: (Cell Phone Number)

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* 2. Is your delivery address in an outlying/remote area that is not close to a main city area? (township, farm, out-of-town etc.)

Yes

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* 3. Your Age:

Under 18 years old

18 -21 years old

22-25 years old

26-30 years old

31-35 years old

36 - 40 years old

41+

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* 4. Your Race:

Asian

Black

Coloured

Indian

White

Mixed

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* 5. Gender:

Male

Female

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* 6. Do you have have aches, pains and inflammation as a result of your everyday activities or lifestyle?

Yes

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* 7. Where on your body do you mostly experience your everyday aches, pains and inflammation?

Neck

Back

Legs

Shoulders

Arms

Feet

Stomach

Hips

Other (please specify)

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* 8. What kinds of activities form part of your everyday life?

Playing with my kids/ carrying them around

My job requires killer heels

Housework (groceries, laundry, mowing, gardening etc.)

Home DIY

My job is physically demanding (walking, plumber, builder, stylist, DJ, etc.)

Walking my dog/s

My intermittent training (walking, pilates, yoga, golf, gym, soccer, rugby, dancing, running, hiking etc.)

My party lifestyle

Other (please specify)

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* 9. Are you currently using a treatment for your everyday aches, pains & inflammation?

Yes