Dietary Supplement Experiment Findings Report
Please provide detailed information and observations about your dietary supplement experiment.
Participant Full Name
*
First Name
Last Name
Participant Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Other
Supplement Name
*
Dosage (please specify unit)
*
Duration of Supplement Use (in days)
*
Experiment Start Date
*
-
Month
-
Day
Year
Date
Experiment End Date
*
-
Month
-
Day
Year
Date
Observed Effects (please rate the following)
*
Rows
Not Observed
Mild
Moderate
Strong
Increased energy
1
2
3
4
Improved focus
5
6
7
8
Better sleep
9
10
11
12
Mood enhancement
13
14
15
16
Other (please specify in comments)
17
18
19
20
Did you experience any side effects?
*
No side effects
Mild side effects
Moderate side effects
Severe side effects
Other (please specify below)
Please describe any side effects experienced (if any)
How compliant were you with the supplement regimen?
*
Not at all compliant
1
2
3
4
Completely compliant
5
1 is Not at all compliant, 5 is Completely compliant
Overall, how would you rate your experience with the supplement?
*
1
2
3
4
5
Additional comments or observations
Submit Report
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