O'shot Orgasm Shot

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1. Please choose one, or more, of the following that best describes your issue with vaginal and sexual health (Required.)

Pain during intercourse or loss of sexual pleasure

Urinary Incontinence

vaginal dryness

Changes in the appearance or color

Chronic unusual bleeding or discharge

Loss of Sexual Pleasure

Not Able to reach Orgasm

Please use this box if you chose "Other" or if you wish to explain your condition in more details

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2. When did start noticing these symptoms (Required.)

After giving birth

After Chemotherapy?

After hysterectomy

After menopause

Other (please specify)

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3. How long have you had these symptoms for? (Required.)

between one to two years

Less than one year

More than two years

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4. Have you tried any of the of the following treatments (Required.)

Vaginal Creams

Hormone Replacement Therapy Tablets

No treatment at all

Education and behavioral interventions

Other (please specify)

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5. Have you heard about O'shot before? (Required.)

Yes

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6. what is your personal perception of O'shot Vaginal treatment safety and efficacy? (Required.)

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7. Please rate the impact of these vaginal symptoms on your life in general (Required.)

insignificant

Moderate

devastating

Clear

i We adjusted the number you entered based on the slider’s scale.

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8. What would be a reasonable price for this O'shot knowing it will be safe and effective? (Required.)

1000

1500

2000

Clear

i We adjusted the number you entered based on the slider’s scale.

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9. please provide your contact information, so we can arrange for a free consultation and to get the $100 coupon.

First Name

Last name

Email Address

Phone Number

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10. How do you like us to contact you

Phone call

email address

Text message

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* 1. Please choose one, or more, of the following that best describes your issue with vaginal and sexual health (Required.)

Question Title

* 2. When did start noticing these symptoms (Required.)

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* 3. How long have you had these symptoms for? (Required.)

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* 4. Have you tried any of the of the following treatments (Required.)

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* 5. Have you heard about O'shot before? (Required.)

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* 6. what is your personal perception of O'shot Vaginal treatment safety and efficacy? (Required.)

Question Title

* 7. Please rate the impact of these vaginal symptoms on your life in general (Required.)

Question Title

* 8. What would be a reasonable price for this O'shot knowing it will be safe and effective? (Required.)

Question Title

* 9. please provide your contact information, so we can arrange for a free consultation and to get the $100 coupon.

Question Title

* 10. How do you like us to contact you

1. Please choose one, or more, of the following that best describes your issue with vaginal and sexual health (Required.)

2. When did start noticing these symptoms (Required.)

3. How long have you had these symptoms for? (Required.)

4. Have you tried any of the of the following treatments (Required.)

5. Have you heard about O'shot before? (Required.)

6. what is your personal perception of O'shot Vaginal treatment safety and efficacy? (Required.)

7. Please rate the impact of these vaginal symptoms on your life in general (Required.)

8. What would be a reasonable price for this O'shot knowing it will be safe and effective? (Required.)

9. please provide your contact information, so we can arrange for a free consultation and to get the $100 coupon.

10. How do you like us to contact you