Trial Offer
 

First Time Customers Only
Get $5.00 Off a 24 capsule bottle of OptisX!

First Tell Us About Yourself Before We Send Your $5.00 Off Trial Offer
(Addresses in USA Only)

 

First Name:
Last Name:
Address:
Address (cont.):
City:
State:   Zip:
Phone:
Email:
Age (Must be Over 18):


Tell Us
What is Most Important (1st) to you in buying OptisX?:
What is Second Most Important (2nd) to you in buying OptisX?:
What is Third Most Important (3rd) to you in buying OptisX?:

    Effectiveness
      How do I know it really works?
      Need more customer testimonials

    Availability
      Want convenience of product availability at (please choose one)
      drugstore, supermarket, health food store, adult store
      Want the ease and privacy to buy online or via toll free 800 #

    Price
      Too Expensive
      Want to try for free

    Safety
      How do I know it’Äôs really safe?
      Need more Physician endorsements

    Credibility
      Never heard of it before
      Need to see media/press coverage on product
      Need to see more advertising on the product

    Other Reason-Please Specify

Would you like to receive free samples and participate in future clinical studies?
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Your information is completely confidential with OptisX. Sometimes 3rd party companies seek to send our customers special discounts and information. Would you like to receive future informational mailings or special offers from 3rd party companies?
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For all orders or customer service, call (866) 286-7879.
*These statements have not been evaluated by the Food and Drug Administration.  This product is not intended to diagnose, treat, cure or prevent any disease.
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