Folinique — Pilot Survey for Adults

Confidential · Pilot Participants Only

Your honest feedback is critical to validating our formulation before we scale production. No personal health information will be shared, sold, or linked to your name in any external context.

Doc ID: FOL-SURV-SELF-001 · Version 1.0

Please complete this survey after taking Folinique for a minimum of 14 consecutive days.

If you discontinued use before 14 days, please still complete the survey and note the reason in the relevant section. All responses are confidential and will be used solely for product development.

Respondent Background Section A

A1What is your age range?

Under 25 25 – 34 35 – 44 45 – 54 55 – 64 65 or older

A2Sex

Male Female Prefer not to say

A3If female, are you currently in any of the following life stages?

Select all that apply, or skip if not applicable

Pregnant Nursing Trying to conceive Perimenopausal Postmenopausal None of these Prefer not to say

A4Body weight range

For dose context

Under 130 lbs 130 – 160 lbs 161 – 190 lbs 191 – 220 lbs 221 lbs or more

A5What prompted you to try Folinique?

Select all that apply

Diagnosed folate deficiency confirmed by bloodwork Known MTHFR variant Doctor or practitioner recommendation Symptoms suggesting a folate issue (fatigue, brain fog, etc.) Adverse reactions or side effects from other folate supplements (methylfolate, folic acid) General wellness / preventative use Other

Folate Context Section B

B1Do you have a known MTHFR variant?

Yes — C677T heterozygous Yes — C677T homozygous Yes — A1298C heterozygous Yes — A1298C homozygous Yes — Compound heterozygous (C677T + A1298C) Suspected but untested No / Unknown

B2Have you previously tried other folate supplements?

Select all that apply

Folic acid Methylfolate (5-MTHF) Folinic acid in another form None — Folinique is my first folate supplement Other

Administration & Compliance Section C

C1What daily dose are you taking?

1 gummy 2 gummies 3 gummies 4 gummies 5 gummies Other

C2How long have you been taking Folinique as of this survey?

Less than 1 week 1 – 2 weeks 3 – 4 weeks 1 – 3 months 3 months or longer

C3How consistent has your daily intake been?

Took every day without missing a dose Missed 1 – 2 days total Missed 3 – 5 days total Missed more than 5 days

C4Do you typically take Folinique with food?

Always with food Sometimes with food Rarely with food Never with food / on empty stomach

Taste & Quality Section D

D1How would you rate the overall taste of the gummies?

1 Disliked → 5 Loved it

1Disliked 2Tolerated 3Neutral 4Enjoyed 5Loved

D2How would you rate the texture or mouthfeel of the gummies?

1 Disliked → 5 Loved it

1Disliked 2Tolerated 3Neutral 4Enjoyed 5Loved

D3Any suggestions to improve taste, texture, or sweetness?

Observed Effects Section E

For each of the following, please rate the change you have noticed compared to before you started taking Folinique.

E7How soon after starting Folinique did you first notice any changes (positive or negative)?

Within 1 – 3 days 4 – 7 days 1 – 2 weeks 2 – 4 weeks More than 4 weeks No changes noticed

E8In your own words, please describe the most noticeable change you experienced (positive or negative)

Adverse Effects Section F

F1Did you experience any of the following while taking Folinique?

Select all that apply

Nausea or stomach upset Headache Changes in sleep (difficulty falling asleep, vivid dreams) Anxiety or restlessness Irritability or mood changes Skin rash or irritation Changes in urine color or odor Fatigue or drowsiness Changes in bowel habits Other None of the above

F2If you experienced any adverse effects, how severe were they?

1 Very mild → 5 Very severe · N/A

1Very Mild 2Mild 3Moderate 4Severe 5Very Severe —N/A

F3How did any adverse effects resolve?

Resolved on their own within 1 – 3 days Resolved after reducing the dose Persisted but were tolerable Required discontinuation of the product N/A — no adverse effects

Product Quality Section G

G1How would you rate the overall appearance of the gummies?

1 Concerning → 5 Excellent

1Concerning 2Below 3Acceptable 4Good 5Excellent

G2How was your experience with the resealable pouch closure?

Easy to open and reseal Functional but could be improved Difficult to open or reseal Failed to seal properly at some point during use

G3Did the gummies stay fresh throughout the entire pouch?

Yes — consistent quality from first to last gummy Mostly fresh — minor changes over time Quality noticeably degraded toward the end Not sure

Overall Assessment Section H

H1Overall, how satisfied are you with Folinique?

1 Very Dissatisfied → 5 Very Satisfied

1V. Diss. 2Diss. 3Neutral 4Satisfied 5V. Sat.

H2How likely are you to continue using Folinique if it were commercially available?

1 Very Unlikely → 5 Very Likely

1V. Unlikely 2Unlikely 3Neutral 4Likely 5V. Likely

H3What price per bottle (30-day supply) would you consider fair?

Under $30 $30 – $45 $46 – $55 $56 – $70 Over $70

H4Would you be interested in any of the following future product variations?

Select all that apply

Lower dose (5 mg) for daily maintenance Higher dose (20 mg) per gummy Liquid format Capsule format Multi-active blend (folinate + B12 + cofactors) Subscribe-and-save monthly delivery at reduced price None of the above

H5Is there anything else you would like us to know about your experience?

For urgent concerns about a reaction to this product, contact your healthcare provider.

Submission Received

Thank you.

Your feedback has been recorded.

We’ll be in touch as the pilot progresses.