1.
What is your email address? (this is for verification purposes. Type in the same email address that we sent our email to).
2.
How old are you?
Under 18
18-25
26-39
Over 39
3.
Gender:
Male
Female
4.
Ethnicity:
African/African American
Asian
Hispanic/Latin American
Middle Eastern
Native American
Pacific Islander
White/European (non-hispanic)
Other
5.
Approximately how many days have you been taking our specially formulated B5 Supplements? (note: this email was sent 1 month after your first order, but that doesn't include the 2-3 days it took for delivery).
6.
On average, how many B5 capsules have you been taking per day?
7.
If you'd like to elaborate on your consistency you can do so here (optional).
8.
On a scale of 1 to 20, using these pictures as a guide, how bad was the acne on your face prior to taking our specially formulated B5 Supplements?
0 No Acne............................................................................................
1
2
3
4
5 Light Acne.......................................................................................
6
7
8
9
10 Moderate Acne............................................................................
11
12
13
14
15 Severe Acne..................................................................................
16
17
18
19
20 Extremely Severe Acne.................................................................
9.
What percentage of the acne on your face has been eliminated?
10.
On a scale of 1 to 20, using these pictures as a guide, how bad was the acne on your shoulders, back, and chest prior to taking our specially formulated B5 Supplements?
0 No Acne...................................................................................
5 Light Acne................................................................................
10 Moderate Acne.....................................................................
15 Severe Acne.........................................................................
20 Extremely Severe Acne........................................................
11.
What percentage of the acne on your shoulders, back, and chest has been eliminated?
12.
Is there anything besides the B5 that could have been responsible for your reduction in acne? (optional).
13.
Have you noticed a reduction in the amount of oil on your skin?
14.
Have you had scarring from acne before?
15.
Did you experience any initial breakout when you started our B5 Supplements?
no
yes, slightly
yes, moderately
yes, severely
not sure
16.
Have you noticed a lightening in your stool thickness?
slightly
moderately
occasional diarrhea
severe diarrhea
17.
Your thoughts or opinions about it? (optional).
18.
Did you experience skin flushing from taking our B5 Supplements? ( a warming sensation on the skin).
yes
19.
Your thoughts or opinions about it (optional).
20.
Did you experience any stomach irritation from taking that many capsules per day?
21.
22.
Are there any other side effects you'd like to report? (optional).
23.
If you asked your dermatologist or physician about vitamin B5, how did they respond? (optional).
24.
Are there any other comments or suggestions that you'd like to make? (optional).
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