Customer Intake Form for Pinkmatter- Pioneering Root Cause PMS Resolution

Pinkmatter is a women's health platform pioneering a radical approach to PMS. Our unique innovation is grounded in the science of the gut microbiome, based on the emerging research showing gut health to play a big role in the onset and severity of PMS. A healthy gut microbiome establishes between the gut, hormones and the brain for smooth functioning, helping overcome PMS related symptoms.

Our goal is to move the needle forward in root-cause resolution of PMS that goes beyond symptom management and treating the disorder as a systemic issue rather than an isolated hormone imbalance issue.

We know that PMS is not one-size-fits-all in symptom and severity, and neither should the be solutions treating it! Our breakthrough products include solutions for varying severity of PMS containing standard and personalized formulations.

Our first product, Foundational Supplement, is specifically created to help resolve moderate PMS. It is a comprehensive formulation of 3-1 products; probiotic and prebiotic blend, multivitamins and minerals and omega 3 fatty acids. The Foundational is meant to replace any other supplements you might be taking for PMS and overall health. This beta study is specifically testing the Foundational Supplement in women struggling with PMS.

Website: https://mypinkmatter.com/ - Sign up for our waitlist to get updates on our launch

Instagram: @Pinkmatter

Email

What is your age

A

15-19

B

20-29

C

30-39

D

40-49

E

50-60

F

60+

How often do you experience premenstrual disorders like PMS or PMDD?

A

Every 2 Weeks/Luteal Phase

B

Not Every Luteal Phase but Often

C

Sometimes

D

Rarely

E

Never

What symptoms of premenstrual disorders do you experience? Select all that apply

A

Cramps

B

Bloating

C

Headaches/Migraines

D

Fatigue

E

Muscle pain

F

Diarrhea

G

Constipation

H

Mood swings

I

Depression

J

Anxiety

K

Irritability

L

Rage

M

Suicidal Ideation

N

Combination of severe mental health challenges

How severely do premenstrual disorders affect your daily life during the luteal phase?

A

Very severely

B

Severely

C

Moderately

D

Mildly

E

Not at all

Have you tried any products to alleviate premenstrual symptoms?

Yes

No

If yes, what products have you tried and what was your experience with them?

How effective do you believe a product specifically designed to eliminate premenstrual disorders would be

A

Very effective

B

Effective

C

Somewhat effective

D

Not effective

E

Not sure

How likely are you to purchase a supplement that shortens the time you experience PMS/PMDD or lessens the intensity, eventually eliminating it?

A

Very likely

B

Likely

C

Somewhat likely

D

Unlikely

E

Very unlikely

How much would you be willing to pay for a product that shortens the time you experience PMS/PMDD or lessens the intensity, eventually eliminating it, on a monthly basis?

A

Less than $20

B

$20-$50

C

$50-$100

D

More than $100

Would you like to be a Beta Tester for the Foundational PM Supplement?
The Foundational PM Supplement is our first launch, specifically recommended to women experiencing moderate severity of PMS. It contains daily packs of 2 capsules with clinically-backed ingredients– probiotics, prebiotics, micronutrients, minerals and omega 3, for a systemic and root-cause approach to PMS resolution

Would you like to be a Beta Tester for the Foundational PM Supplement? The Foundational PM Supplement is our first launch, specifically recommended to women experiencing moderate severity of PMS. It contains daily packs of 2 capsules with clinically-backed ingredients– probiotics, prebiotics, micronutrients, minerals and omega 3, for a systemic and root-cause approach to PMS resolution

A

Yes

B

No

Would you like to be a Core User of Pinkmatter's products?
A Core User will be instrumental in helping Pinkmatter's R&D in developing personalized solutions to resolve their severe PMS and PMDD.
PS: One can be a Beta Tester and a Core User.

Would you like to be a Core User of Pinkmatter's products? A Core User will be instrumental in helping Pinkmatter's R&D in developing personalized solutions to resolve their severe PMS and PMDD. PS: One can be a Beta Tester and a Core User.

A

Yes

B

No

What other features would you expect from a product that provides relief for premenstrual disorders?

How likely is it that you would recommend a product that eliminates premenstrual disorders to a friend or colleague?