Customer Intake Form for Pinkmatter's Supplements

Pinkmatter is a consumer health platform pioneering personalized solutions for the resolution of premenstrual disorders like PMS and PMDD, beyond symptom management. Our breakthrough approach is rooted in the gut microbiome's key role in the onset and severity of premenstrual disorders.

We understand that PMS/PMDD are highly variable disorders, both in symptom and severity, and can be extremely disruptive to daily life and well being.

Our supplements contain clinically-backed probiotics, prebiotics, micronutrients and omega 3 that specifically work to address physical, mental and GI-related symptoms associated with premenstrual disorders by optimizing the gut microbiome's health and filling the necessary nutritional gaps. Our supplements are comprehensive in formulation and are meant to replace all the other supplement products you may be consuming to help your premenstrual disorders and their symptoms.

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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?