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Tell Us How You Feel
Your feedback is valuable to us. Please use the form blow to share your Limbrel experience or to submit any requests or questions. If you have had or are having an adverse event to Limbrel, contact your physician immediately and report it to Primus using the form below.
First Name
Last Name
Address
City
State
Zip
Email
Telephone
Age
How many weeks have you been using Limbrel?
(Enter 0, if you have not used Limbrel)
How did you hear about Limbrel (check all that apply)?
Physician
Physician’s Assistant
Nurse Practitioner
Pharmacist
Family Member
Friend
Internet
Advertisement
Article or Interview
Other:
(please write in)
Type of feedback (check one):
Feedback &
Comments
Question
Product
Complaint
Product
Praise
Tell us how it feels to live with your
condition
before
you tried Limbrel
Tell us how it feels
after
you have tried Limbrel
Which improvement did you notice first after taking Limbrel?
(please check one, or write in others)
Less Morning Stiffness
Less Stiffness in General
Improved Mobility in General
Less Joint Discomfort
in General
Other Improvement(s)
How soon did you notice the above improvement after taking Limbrel?
(please check one)
1st day
2-3 days
4-5 days
6-7 days
8-9 days
10+ days
Which Limbrel strength were you taking when you noticed the above improvement?
(please check one)
250 mg
1 time a day
250 mg
2 times a day
250 mg
3 times a day
500 mg
1 time a day
500 mg
2 times a day
500 mg
3 times a day
Other Feedback or Question
My physician who prescribed Limbrel to me (or please contact my physician about Limbrel):
First Name
Last Name
Specialty
Address
You have my permission to
contact my doctor listed here
regarding my feedback:
YES
NO
City
State
Zip
Phone
Fax
Survey Follow-up (check all that apply):
Please do not contact me in the future
Please contact me to discuss my feedback on Limbrel
Please provide more Limbrel information to me
Please email someone I know with Osteoarthritis Limbrel information
The names and email addresses or phone numbers of my friends to contact are as follows:
Name
Email
Phone
