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What year were you born?
*Date of Birth:   (YYYY)

How did you first learn about Vitaball?
First Learn
Internet
Television
Magazine ad
Radio 		Saw packaging on shelf
Newspaper coupon
Friend/family/colleague
Healthcare professional 		Pharmacist
In-store display
Direct mail
Other:

If you or your children currently take a children's multi-vitamin, which brand(s) do you typically use? (Check all that apply.)
Typically Use
Bugs Bunny
Centrum Kids
Flintstones
L'il Critters Gummy Vites
Marvel Super Heroes
One-A-Day Kids Scooby Doo 		Poly Vi Sol
Vitaball
Yummi Bears
Store brand/generic
Take adult vitamins
Do not take a children's multi-vitamin
Other:

If your household is currently using Vitaball, approximately how many times per year do you purchase it?
Times per year
1
2
3 		4
5
6 		7
8 or more
Not currently using Vitaball

Which other Amerifit Nutrition products, if any, are you interested in?
Other
Estroven Caplets/Gelcaps
Extra Strength Estroven
Estroven PMS
Estroven Menopause Monitor
Estroven Calci-Fresh Gum
Estroven Calcium Advantage
Estroven Joint & Bone
Estroven Healthy Heart 		Estroven Multi-Vitamin
Estroven Feminine Moisturizer & Lubricant
Sootherbs
Flex Able Joint Care
AcuTrim
DHEA
None
All

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