Are you or is a loved one among the 10.7% of folks in the U.S. suffering from the pain of eczema?

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Request for pre-market sample of EPSOMA®-XZ treatment for eczema, shipped prepaid only to U.S. address

Name of User:
Age:
Sex:

Please make a selection.
Address:
Email address:
Duration of Eczema:
Parental Permission for Use if user is under age 18:
 
Please make a selection.
   
Eczema Treatments used previously and satisfaction rating (1 lowest, 10 highest)
Prior Treatment, Trademark Rx OTC Rating Prior Treatment Rx OTC Rating
Hydrocort 10 X Please make a selection. A value is required. Benadryl pill X Please make a selection. A value is required.
        UV light treatment X   Please make a selection. A value is required.
Dermarest medicated gel X Please make a selection. A value is required. Oxyvectin pill X Please make a selection. A value is required.
Aveeno Soothing Bath X Please make a selection. A value is required. Naturasil X Please make a selection. A value is required.
Aveeno Eczema Control X Please make a selection. A value is required. A&D ointment X Please make a selection. A value is required.
Gold Bond Eczema Lotion X Please make a selection. A value is required. Exzaderm X Please make a selection. A value is required.
Grandma's Rash Remedy X Please make a selection. A value is required. Puremedy X Please make a selection. A value is required.
Bleach X Please make a selection. A value is required. Baking soda X Please make a selection. A value is required.
Store brand of hydrocortisone:
What store? A value is required.
X Please make a selection. A value is required. Prescription hydrocortisone:
What % A value is required.
Please make a selection. X A value is required.
Other: A value is required. A value is required. Other: A value is required. A value is required.
Other: A value is required. A value is required. Other: A value is required. A value is required.
Other: A value is required. A value is required. Other: A value is required. A value is required.
               
   
How often do you treat the eczema?:
or Only when it itches Please make a selection.
Have you needed to apply the treatment more often since the eczema began?
 
What packaging do you prefer for an eczema treatment?
 


Please make a selection.
Are you willing to take photos of your use before and after treatment?
 
Please make a selection.
Will you consider use of such photos in promotional media for SatisHARMA, LLC in return for payment of $100?
 
Please make a selection.
Please make a selection. By checking this box I verify that this information is accurate to the best of my knowledge.
   
   
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SatisPHARMA, LLC

Ray HauserHas been self-funded by Ray Hauser during its first 16 months of operation and has announced a Private Placement Memorandum for initial private funding of the company, to be followed soon by "crowd funding" following the guidelines of the LABOR act of 2012.


Available only from:

SatisPHARMA, LLC
P.O. Box 19170
Boulder, Colorado 80308
Tel 303-527-0344
info@satispharma.net
www.satispharma.net


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