Testimonial

 

USER PROFILE

Name *
Gender *
Male   Female
Country of residence *
Age *
Email *

PRODUCT & USAGE INFORMATION

Name of product used: *
Range of the product used: *
Indication (specify the medical condition, illness, pathology or a reason/indication for application of the product. If it is for the general anti-aging purposes or aesthetic purposes kindly specify so) *
Route of administration of the product *
Dose, frequency and duration of administration *
Effects and outcomes observed in terms of the Indications and expectation (kindly use the general medical descriptive language to specify the observed outcomes, mention the extent of the outcomes and improvements observed from the physician’s point of view) *
Other effects observed, not related to the main indication (kindly specify other changes in end user’s condition, which are not related to the main indication or illness, but that also had improvements during or after products use) *
Any adverse reactions observed *

PERSONAL FEEDBACK

Kindly provide supportive data and evidence in a form of blood results “before and after”, photos of “before and after”, imaging study or any other objective information (end user’s identity and personal information will be kept strictly confidential. Data may be used for statistical purposes only).

Max file size limit 1MB. If file size too large, please email file separately to info@labrms.com.


Please share personal subjective feedback about the product’s effect (End user or use exactly the same words, expressions that end user gave to describe the effect of the product) *
Other products or treatments used concurrently with the product *
Additional comments

CERTIFIED BY

Name of Physician / Therapist: *
Name of Institution *
Address *
Certified Date *
Terms & Conditions *
  By submitting my testimonial, photo & files, I agree my testimonial to be used by LABRMS or any of it's related companies on any marketing channel and materials at any time and at LABRMS's discretion.