Travel Pack Survey

Full Name

Email *

Phone *

What issue(s) are you struggling with now (back/joint discomfort, fatique, stress, focus, stomach issues, etc...)? *

What Area(s) Of The Body is this Primary Affecting? *

PLEASE SCORE THIS PROBLEM ON A SCALE OF 0-50:

0-5: No health issues (no or little back/joint discomfort, fatigue, stress, stomach issues, etc.)
6-14: Mild health issues
15-24: Moderate health issues
25-34: Severe health issues
35-50: Completely disabled (unable to function normally)

Score Before Exodus (0 - 50) *

Date Before Taking Exodus *

After Taking Exodus (Minimum 20 Minutes)

Score After Taking Exodus (0 - 50) *

Date After Taking Exodus *

How Many Capsules of Exodus Did You Take and Over What Timeframe? *

What Changes Did You Notice? *

Other Comments

Will You Share This Product With Your Friends and Family?

Yes

Possibly

Can We use Your Testimony On Our Website? *

Yes

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