← Pilot Survey Document 02·a / 03
Pilot · For Caregivers

Pilot Survey

For a parent or legal guardian completing this on behalf of a child.
Confidential · Pilot Participants Only

Your feedback shapes the formula before we scale.

Doc ID: FOL-SURV-CHILD-001 · Version 1.0

Please complete this survey after your child has been taking Folinique for a minimum of 14 consecutive days.

If your child discontinued use before 14 days, please still complete the survey and note the reason for discontinuation. All responses are confidential and will be used solely for product development purposes.

Participant Information Section A

Administration & Compliance Section B

1 Very Difficult → 5 Very Easy

Taste & Palatability Section C

These questions help us optimize the flavor and texture for broad taste acceptance.

1 Refused → 5 Liked It

Observed Effects & Behavioral Changes Section D

Rate any changes you observed during the evaluation period. Select N/A if the area is not relevant.

Adverse Effects & Tolerability Section E

1 Very Mild → 5 Very Severe · N/A

Product Quality & Packaging Section F

Color, surface, firmness · 1 Concerning → 5 Excellent
1 Very Poor → 5 Excellent

Overall Assessment Section G

1 Very Dissatisfied → 5 Very Satisfied
1 Very Unlikely → 5 Very Likely
1 Very Unlikely → 5 Very Likely

For urgent concerns about your child’s reaction, contact your healthcare provider.

Submission Received

Thank you.

Your feedback has been recorded.

We’ll be in touch as the pilot progresses.