At Wicken Fen we are constantly trying to improve and monitor our products and we would be most grateful if you would complete the following questionnaire - if you let us know your contact details we will send you a week’s supply of Nutrivert as a “thank you”.

Did you notice a change in any of the following?  Please use the buttons for your answers:

Appetite

Energy levels in pm

Sleep quality

Concentration

Bowel movements

Condition of hair

Condition of nails

Joint pain

Weight

Condition of skin

Energy levels in am

My weight in Kgs is approximately:

My occupation is:

I play sport (Y/N)

How did you take Nutrivert (eg in juice/on food)

How much did you take per day?

What time of day did you take it?

Did you change the foods that you normally eat as a result of taking Nutrivert?

Are you going to continue taking Nutrivert?

Would you be prepared to be contacted to discuss this survey? (Y/N)

First Name

Last Name

Address 1

Address 2

Address 3

Postcode

Email address

Contact tel number

Week 2

Week 4

Week 6

Week 8