2007 Chin-Up Strip Common Cold Report Form

If you used Chin-Up Strips regularly during the entire year 2007, please submit your annual Common Cold Report online by answering the questions below and clicking on Submit.

You can submit your report by calling us at 1-888-835-4563, or by email or snail mail or by printing this form and faxing it to us at 1-678-482-8509. Submit your report and we will send you a free 30 pack as indicated below.

When you replace your 2007 calendar, submit your report about your common cold experience during 2007.

We will send you a FREE 30 pack of the strips you use, after you send us your 2007 common cold report.

We will send a free 30 pack with the next order after you send us your report. Please let us know if we ever forget to send your free 30 pack.

Please fill out the form below to submit your report:
* All Fields Are Required Unless Indicated*


1.  Which type of Chin-Up Strip do you use?




2.  How long have you been using Chin-Up Strips?




3.  How often do you use a Chin-Up Strip?





4.  How often do you use Breathe Right nasal strips?





5.  How often do you use a Cpap or Bipap machine?





6.  How often do you use an oral dental appliance?





7.  Did you have a Common Cold during 2007?






8.  Did you have a sinus infection during 2007?



9.  Would you also keep an annual record of sinus infections on your calendar?



10.  Would you also report any sinus infections along with your common cold report?



11.  During 2007, did you use a Chin-Up Strip during an airline flight?


12.  Additional Comments: (optional)

13.  Please provide Your Name, Phone Number and Email Address:

        First Name:

        Last Name:

        Phone Number:

        Email Address: (optional)