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First Name *
Last Name *
Gender
Age *
<25 26 - 35 36 - 45 46 - 55 56+
Date of birth
Marital status
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Working status
Full time Part time Not working Student
Address *
Suburb *
State *
Postcode *
Telephone (home)
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Email *
What is your biggest nailcare concern(s)?
Brittleness
Softness
Ridges
I have no concerns
Which Revitanail products(s) did you purchase?
Strengthening products
Nail Strengthener
Sensitive Pink
Sensitive Apricot
Treatment products
Base Coat
Top Coat
Ridge Filler
Nourishing Oil
Nail Polish Remover
Hand & Nail Cream
Manicure products
Coral Cascade
Paint The Town
Miss Scarlet
Cherry On Top
Ruby Rich
Port Wine
Posh Champagne
Cashmere Latte
Barely There
Cherry Blossom
Pink Diamonds
Perfect Pink
French Manicure Kit
Place of purchase
Amcal (selected stores)
Arthur Barnett Dunedin
Ballantynes
Farmers (selected stores)
H & J Smiths (Gore & Invercargill)
Kirkcaldies
Life (selected stores)
Radius (selected stores)
Unichem (selected stores)
Not applicable
Date of purchase
dd-mm-yyyy
Who/what influenced you to buy this product?
Friend
Mini samples in gift with purchase
Mother
Pharmacist
Department store
Special promotion
TV commercials
Word of mouth
Web/E-newsletter
None
Other - please state
Magazine(s)
Cleo New Zealand
Cosmopolitan
Fashion Quarterly
InStyle
Karen
Marie Claire
MiNDFOOD
New Idea
New Zealand Woman's Day
New Zealand Women's Weekly
Next
Notebook
OK! Magazine
Pharmacy Today
Simply You
Shop Til You Drop
Who Weekly
Would you purchase the same product in the future?
Yes No
In the past 3 months, have you
Used nailcare products
Used nail polish products
Visited a nail salon
What other brands do you use?
Chanel
Creative (Nail Design)
Cutex
Kiss
L'Oreal
Manicare
OPI
Revlon
Sally Hansen
Other - please state
What other products would you like to see added to the Revitanail range?
Please confirm if you would like to receive promotional updates and information on Revitanail
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