Water Awareness Survey

Enter to win…

The following is an information gathering survey about the water You drink.

Please answer all the questions and fill in all information to be entered to win a FREE “Alkalize Your Body” e-book and a FREE Water testing at your home or office.

Your information is Confidential and will not be sold. Thank you.

Name

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How do you rate your local tap water for quality? 1-2-3-4-5 (Disappointing to Exceptional)?

Do you drink bottled water? 1-2-3-4-5 (Never to Daily)?

Do you drink sports or energy drinks or sodas? Yes - No (If Yes, How many a week?)

Do you recycle your plastic bottles? 1-2-3-4-5 (Never – Always)

Did you know that the USA alone uses enough plastic bottles to stretch around the Earth more than 190 times? Yes – No

Is this environmental consequence important to you? Yes – No

Are you concerned about your or your loved ones’ health? (Not healthy – Exceptional health)

Do you know of anyone that struggles with cancer, diabetes, arthritis, acid reflux, gout?

Do you drink RO (reverse osmosis) or Distilled water? Yes –No (If so, how long? _________)

Most bottled/ processed waters are Acidic and/or Oxidizing. If you drink bottled water, what is your choice of brand and how many bottles do you consume a day? _______________

Does your tap water contain chemicals such as Chlorine, Chloramine, Fluoride, Lye..? __________

Have you heard of alkaline, restructured, antioxidant waters? Yes – No (If Yes: What type? ____)

Have you heard of ERW (Electrolyzed reduced water) a.k.a. Kangen water?

With most water being oxidizing (aging, rusting, free radical producing), do you take antioxidants currently? Yes – No (If so, what type, which kind?____________________)

Thank you and good luck!

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Water Awareness Survey

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Orshi Liptak-Bennet