JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Osmose Health Smart Pill Container Pre-order Form
Please take 2 minutes to fill out this form so we can help serve you better!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
What is your email?
*
Your answer
What age demographic do you fit in?
*
18-34
35-49
50-65
65+
How many pills or vitamins/supplements do you take per day?
*
0-5
6-10
11-15
15+
What are you interested in the most?
The mobile app
The combo of smart pill container and the mobile app
Neither
Other:
Clear selection
What country do you live in?
*
Your answer
What demographic do you classify as?
*
Fitness Fanatic
Elderly Person
Caregiver
Healthy but have chronic illnesses where I need to take pills for everyday
Other
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
