Nutri-Pharm
                                                   Leaders in Innovative Scientifically Developed Natural Products
 
 
 
 

 

 

   

 

Product Feedback Form

       
  Name  
  Email address  
     (please supply name & email address so we can respond to your feedback)  
       
  Which Nutri-Pharm product(s) have you been using?
( you may select more than one)		 Austral-Balm  
  Austral-Balm Lite  
  Myopax  
  Myopax Lite  
  Psoria  
  Oils of the Outback - Vital  
  Oils of the Outback - Serene  
  Oils of the Outback - Harmony  
  Oils of the Outback - Indulgence  
  Oils of the Outback - Masculine  
  Supreme Massage Oil  
  Crystal  
  Professional's Blend  
       
  For what duration have you used the products? Less than 1 week  
  1 - 4 weeks  
  2 - 6 months  
  More than 6 months  
       
  Main Condition/Reason for using product
( you may select more than one)		 Fibromyalgia  
  Psoriasis  
  Sciatica  
  Arthritis  
  Eczema/Dermatitis  
  Massage Therapy  
  Rheumatism  
  Ankylosing Spondylitis  
  Back Pain  
  Sports Injury  
  Other Conditions  
       
  If you selected 'other condition', please specify  
       
  Following use of the product(s), which selection best describes any changes to your condition? Significant improvement
 Slight improvement
 No change
 Slight worsening
 Significant worsening		  
       
  Comments  
       
  When using the product(s), have you been able to decrease or stop other medicines/pain relievers used for the same condition? Yes
 No
 N/A		  

                                   
Thank you. We greatly appreciate your feedback.
 


PRIVACY STATEMENT
 All personal details will remain confidential within the Nutri-Pharm organisation and will not be divulged to any third party without the express written permission of the owner in accordance with Australian Privacy Legislation – Privacy Act 1988 (Commonwealth of Australia).
 
 
 







 

 


 

 



 



 


 

 

 

 

 

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  Registered Address:
102 Myers Road, Bittern
Victoria 3918  Australia

Postal Address:
PO Box 7313, Karingal Centre
Victoria 3199  Australia

Tel + 61 3 5983 8525
Fax +61 3 9789 6404
Email : info@nutripharm.net 

 ABN: 37 091 353 794