We will be obliged if you can answer the questions below. The information you give will be treated in confidence and it will help us in structuring our services to your exact needs. Thank you.

YOUR AGE GROUP

HOW OFTEN DO USE HERBAL MEDICINE?

15-25

ALWAYS

25-40

SOMETIMES

40-65

RARELY

GENDER

HOW MUCH DO YOU SPEND ON HEALTH PRODUCTS IN A MONTH

MALE

£0-£10

FEMALE

£10-£50

£100 OR MORE

Comments:

Address
City State/Prov
Country Zip/Post Code
Phone
E-mail
 
To contact us:
Phone: 00 44 (0)1274 721755
Fax: 00 44 (0)1274 721755
Email: hakimrana@aol.com 		108, Lumb Lane, Manningham,
Bradford, BD8 7RS
W. Yorkshire, UK