Try RestoraLAX® Please answer the following 3 questions to qualify for the trial offer.NOTE: Limit of two (2) trial offer deliveries per mailing address 1.How did you learn about this RestoraLAX® trial offer? Television Online Family / Friends Doctor Pharmacist Other(please specify): 2.Which statement best describes your use of RestoraLAX®? I typically use RestoraLAX® for occasional constipation relief I have tried RestoraLAX® before, but don’t usually use it for my constipation relief I am trying RestoraLAX® for the first time 3.Which products, if any, would you typically use for relief of occasional constipation/ irregularity? (Please select all that apply) None Metamucil Senokot Dulcolax Ex-Lax Lax A Day Store Brand Other Please answer all the questions. Next Try RestoraLAX® Thank-you for completing the questionnaire! You now qualify for the trial offer. To receive your trial product, please provide the information requested below.NOTE: Allow up to 4 weeks for delivery First Name*: Last Name*: Street Address*: Street Address 2: Invalid address City*: Select Province*: Select Province* British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland & Labra Nunavut Northwest Territorie Yukon Postal Code*: Submit
