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Canker Sore Relief Survey

 Please take a few minutes to answer our Aphthasol consumer survey. Your feedback is appreciated and will be used to determine the need for improvements or extensions of the Aphthasol product line.
Your e-mail address:

How Frequently Do You Get Aphthous Ulcers (Canker Sores)?:

a few times per year
once per month
twice per month
three times per month
constantly


On Average How Severe Are Your Aphthous Ulcers (Canker Sores)?
(Scale 1-10; 1-not very severe, 10- very severe)
1 2 3 4 5 6 7 8 9 10


How Long Has It Been Since You Were First Prescribed Aphthasol ?:

1-2 months
3-4 months
5-6 months
more than six months

How Effective Do Feel Aphthasol Is?
very effective
somewhat effective
not effective

Would You Recommend Aphthasol to a Friend?
yes
no
maybe

Please list any comments or suggestions below:

Thank you for your time and attention

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