Physician Survey

By filling out this short questionnaire, you’ll be automatically entered in our draw to win 12 bottles of AREDS 2 Capsules and 12 bottles of Tear Support for your patients.
Please complete the survey by May 15th.

    Physician Name*



    Phone*



    Physician Email*



    Street Address*



    City*



    State*



    Zip Code*



    1. What feature(s) are most important when referring AREDS 2? (check all that apply)



    2. Did you know that some leading AREDS 2 brands have double the daily upper tolerable levels of zinc? Excess levels of zinc can cause nausea, stomach pains, and a higher rate of UTIs & Kidney stones.



    3. Is there something we can provide better for patients and/or your office? Patient literature, more samples, etc



    4. Did you know we have these other products?
    Viteyes Blue Light Defender (adult and kids), Viteyes Tear Support (For Occasional Dry Eye), Viteyes Omega-3 TG, Viteyes Optic Nerve



    5. How confident are you in referring Viteyes supplements to your patients? Rate 1 – 10 (1 meaning not confident, 10 meaning confident)



    6. Would you like to receive free Viteyes patient samples at your office?