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Dear Patient,

CommonSense Ltd. is constantly striving to improve its products and services.
We would greatly appreciate your help. Your completion and submission of the questionnaire below will provide us with valuable input that will aid us in achieving this objective.

Thank You
Mr. Menashe Terem - CEO
info@cs-commonsense.com

Product Name

Date purchased:     Country:

Did you easily understand the user instructions?     Yes     No

What were the test results?     Green/Blue     Yellow

Did you report these results to your physician?     Yes     No

Did the product aid the decision process?     Yes     No

Was it easy to use the test kit?     Yes     No

Would you use this test again if needed?     Yes     No

Would you recommend it?     Yes     No

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For further details about Common Sense products in the USA, please contact:
Mr. Amir Karp
Common Sense Marketing
100 Herricks Road
Mineola, NY, 11501, USA
Tel: 516-640-3951