Please cooperate to answer the questionnaire as many questions as you can.
We never disclose your personal information.

◆ Have you ever used oblate?
Often Sometimes Carrying
Used by family Seldom
Never
◆ How many pieces of oblate do you use a day?
1〜3 4〜9 10〜19 20〜
◆ Is oblate round or a bag shape?
Round Bag shape Both
◆ Do you take a tablet or capsule?
Yes No
Remove the capsule, wrap the medicine with oblate and take it.
◆ When using oblate, what do you wrap with oblate?
Powder medicine Chinese medicine
Health food Use for cooking stuff
Others
◆ Will you use a flavored color oblate for your child if any?
・Orange flavored and orange color oblate
・Chlorophyllous flavored green oblate
Yes Depending on color agent and additive No
◆ What is essential for oblate?
Safety Easy to use Easy to take
Low Price Reliance of the company
Others
◆ Where do you buy oblate most?
Drugstore
Supermarket, Department store
Pharmacy Hospital Health food store Mail order
Others
◆ The store you use often?
　
◆ Name
　Sex 　Age
　Occupation
◆ Postal code
◆ Address
（Ex.:3-3 Shimizuno Hitokuwada, Shinshiro, Aichi）

◆ Mail address

◆ Home page if any

◆ Your opinion

Thank you very much.