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ABBOTT HT Campaign 2025
Personal Informations:
First Name
(Required)
Last Name
(Required)
Email
(Required)
Cell Phone
(Required)
Group Age
(Required)
18-30
31-40
41-50
51-60
60+
Ethnicity
(Required)
Western
Middle Eastern
Asian
African
Latin American
Gender
(Required)
Male
Female
Open Questions:
Last time you had checked blood glucose?
(Required)
< 1 year
1-2 years
2-3 years
Never
Last time you had checked your blood pressure?
(Required)
< 1 year
1-2 years
2-3 years
Never
Last time you had checked cholesterol levels?
(Required)
< 1 year
1-2 years
2-3 years
Never
How often do you visit a healthcare professional (e.g., doctor, dentist)?
(Required)
Monthly
Every 6 months
Yearly
Only when needed
Never
How did you hear about the abbot campaign?
(Required)
Social Media
Word of Mouth
Poster/Flyer
Other
Please specify how you heard about the campaign
Data Disclaimer:
(Required)
I have read the disclaimer above and acknowledge it.
We respect your privacy and are committed to protecting your personal information. Rest assured that any data you provide will be used solely for the purposes outlined in our communications and will not be shared with any third parties.
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Unique ID
Email
This field is for validation purposes and should be left unchanged.
