PMS questionnaire

Questionnaire addressed to users of
ViruBLOC ORAL FRESH Spray and / or ViruBLOC NASAL MICROGEL Spray

If the questionnaire refers to a child, fill it in as if you were the child, limited to what you can know.

The marked red field * indicates that the answer is mandatory.


 

years
What gender are you?
Do you suffer from chronic sinusitis?
Do you suffer from chronic rhinitis?
Do you have a deviated septum?
Do you suffer from seasonal allergies?
Do you suffer or have you suffered from respiratory diseases other than the common cold?
Have you suffered from a cold in the past 12 months?
times
times
When did you start using ViruBLOC?
If you've had cold-like symptoms and used ViruBLOC, how did they look compared to the times you didn't use it?
 (0 = absent; 7 = extremely intense)
Questions 0 1 2 3 4 5 6 7
(0 = in no way; 7 = completely)
Questions 0 1 2 3 4 5 6 7
If you have used ViruBLOC before having any symptoms
When you used ViruBLOC, did you experience any of the following effects?
When you used ViruBLOC, did you have any problems even apparently unrelated to its use?
While using ViruBLOC, did you take any other cold remedies?
Have you used ViruBLOC following nose or oral surgery?
If you are a woman, have you used ViruBLOC during pregnancy or breastfeeding?
Which of the two devices did you use?
Before spraying, did you always press the dispenser a few times?
times
sprays
Where did you direct the dispenser?
After spraying, did you distribute the product in your mouth?
If so, how?
Did you clean the dispenser after use?
(If you give multiple sprays in quick succession, they count as once):
times
days
Did you find it easy to use ViruBLOC ORAL FRESH Spray?
Before spraying, did you shake the bottle?
Before spraying, did you always press the dispenser a few times?
times
Before spraying, did you tilt your head back?
How did you spray ViruBLOC NASAL MICROGEL SPRAY?
sprinkles
Did you clean the dispenser after use?
(Se davi più spruzzate in rapida successione, contano come una volta sola)
times
days
Did you find it easy to use ViruBLOC NASAL MICROGEL Spray?
years
If ViruBLOC was used on a child:
Do you think the information for the use of ViruBLOC was clear?
Have you had any doubts about the use of ViruBLOC?
Do you think you will use ViruBLOC again?