Please complete the following form to receive a free sample in 8-10 weeks. Only
one sample per household. Offer good in the United States only, void where
restricted or taxed.
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* 1. Were you familiar
with the Beyond BodiHeat brand prior to visiting this site? |
yes
no
unsure |
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* 2. How did you hear
about Beyond BodiHeat? (Check all that apply) |
Prevention magazine advertisement
Arthritis Today magazine
advertisement
AARP magazine advertisement
Driving Force magazine
advertisement
Newspaper
Radio
TV
Recommended by doctor
Recommended by friend or family
Found in a store
Search Engine/Web Surfing
Email Newsletter
other |
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*3. Do you currently use/purchase disposable heat pads?
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yes
no
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*4. If you currently use or purchase disposable heat pads, which brand do you
buy? (Check all that apply)
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Beyond Bodi Heat
ThermaCare
Playtex Heat Therapy
Cura Heat
ACE brand Heat Therapy
Well Patch Heat Warming Pad
Private Label
Have not used disposable heat pads
other
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*5. Beyond BodiHeat is introducing two new products; BodiWrap and Neck and
Shoulder (please click to preview our new products). Which of our product line
would you be most interested in?
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BodiWrap
(Ideal for treating lower back pain using a stretchable belt)
Neck
and Shoulder (Perfect for isolated areas of pain such as shoulder, neck, arm,
etc.)
Original
BodiHeat (12 hours over the clothing for back, neck, or shoulder)
None
All of the above
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*6. In your opinion, which of the following products and/or medications do you
believe works the best to relieve your muscle or joint pain?
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OTC Pain Relief Medication
(Tylenol, Advil, Aleve, Motrin, etc)
Medicated Patch (Icy Hot,
Salonpas, Bengay Patch, etc)
Topical Creams and
Rubs (Icy Hot cream, Tiger Balm, Bengay rub, etc)
Disposable Heat Pad
(BodiHeat, ThermaCare, etc)
Heating Pad (electric heating
pad, microwavable heating pack, etc)
None of above
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*7. In regard to the products and/or medications above, where do you usually
purchase them?
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Supermarket
Pharmacy
Drugstore
Discount Store
Online Store or Catalog
Specialty Store
other
None of above
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*8. Which part of the body do you use and/or plan to use Beyond Bodi Heat to
help relieve pain and discomfort?
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Upper Back
Lower Back
Neck
Shoulders
Knees
Abdominal
other
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*9. What physical activities do you enjoy?
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Golf
Tennis/Racquetball
Skiing/Snowboarding
Hunting/Fishing
Baseball/Softball
Swimming
Weight
Lifting/Exercising
Hiking/Camping
Bowling
Jogging/Running
Long Distance
Walking
other
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*10. Please tell us which magazines you subscribe to or read regularly? (Check
all that apply)
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Shape
Arthritis Today
Prevention
Sports Illustrated
AARP
Newsweek
Time
ESPN Magazine
Cosmopolitan
Men's Health
Women's Fitness
Runner's World
other
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* 11. How old are you? |
Under 9
10-19
20-29
30-39
40-49
50-59
60-69
Over 70
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* 12. What is your
gender? |
Male
Female |
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*First Name |
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*Last Name |
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*Address 1 |
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Address 2 |
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*City |
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*State |
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*Zip Code |
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Phone Number |
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*Email Address |
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Comments |
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