Full Name Mobile
Email Address
Suburb Pincode
Date Of Birth (dd/mm/yyyy) Residence Phone No.
Organization Designation
Height in ft/inches Weight in Kgs

Slim-4-Sure feedback

Are you using all products regularly

Therma Trim Slim
Biolax
Celfatrim
DVD Yoga exercise
Slim-4-Sure Diet
Dinacharya SMS
Remarks :

Do you face any concern in using products

Remarks :

Do you feel any change in yourself after using products

Lightness/ more flexibility in body
Reduced weight (mention kgs in remarks)
Reduced inches (mention where and how much in remarks)
Freshness/ Alertness / Lively feeling
None of the changes mentioned above
Any other ? (add in remarks)
Remarks :

Would you line to recommend the product to any of your friend/relative

Remarks :
Follow Up Date (dd/mm/yyyy) Grand Total