HRC Beta Study Update Form

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PARTICIPANT INFORMATION

Full Name

First

Last

PRODUCT #1

Layout

Name of Dispensary

Product Name / Description

File Upload - Picture of Product Label

Click or drag a file to this area to upload.

Date of Purchase

Quantity Purchased

PRODUCT #2

Layout

Name of Dispensary

Product Name / Description

File Upload - Picture of Product Label

Click or drag a file to this area to upload.

Date of Purchase

Quantity Purchased

PRODUCT #3

Layout (copy)

Name of Dispensary (copy)

Product Name / Description (copy)

File Upload - Picture of Product Label

Click or drag a file to this area to upload.

Date of Purchase (copy)

Quantity Purchased (copy)

PRODUCT #4

Layout (copy) (copy)

Name of Dispensary (copy) (copy)

Product Name / Description (copy) (copy)

File Upload - Picture of Product Label

Click or drag a file to this area to upload.

Date of Purchase (copy) (copy)

Quantity Purchased (copy) (copy)

PRODUCT #5

Layout (copy) (copy) (copy)

Name of Dispensary (copy) (copy) (copy)

Product Name / Description (copy) (copy) (copy)

File Upload - Picture of Product Label

Click or drag a file to this area to upload.

Date of Purchase (copy) (copy) (copy)

Quantity Purchased (copy) (copy) (copy)

DISCLAIMER

Thank you for participating in The Herbal Rubik’s Cube (HRC) Beta Study. Your participation is voluntary, and your data will be used solely for research purposes, ensuring confidentiality and compliance with applicable laws. Please note that participation does not substitute medical advice; consult your healthcare provider before making any decisions. HRC does not guarantee the accuracy of the provided information. By submitting this form, you consent to participate and agree to these terms, as well as to our Privacy Policy and Terms of Service available on our website.