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You must be at least 18 and live in the United States.

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I agree to the Offer Terms and understand I am creating a QualityHealth account. I agree to the Sharecare Privacy Policy, Terms, and, if applicable to me, the Privacy Notice for California Residents. I consent to Sharecare?s processing of any health information I may provide, for the purposes listed in the Privacy Policy. I agree to receive emails, offers, alerts, and other notices. I understand that I can opt-out of marketing communications at any time.

1.	Are you or a family member living with Crohn’s Disease (CD) or Ulcerative Colitis (UC), commonly referred to as Inflammatory Bowel Disease or IBD?

	Yes, I am
	Yes, a family member
	No

2.	Have you or someone you care for been diagnosed with Cancer?

	Yes, I have been diagnosed
	Yes, someone I care for has been diagnosed
	No

3.	Do you or someone close to you have Psoriasis?

	Yes, I do
	Yes, someone close to me
	No

4.	Have you or someone you care for been diagnosed with a sleep disorder characterized by excessive daytime sleepiness and/or sudden attacks of sleep?

5.	Gastroesophageal Reflux Disease (GERD) and Eosinophilic Esophagitis (EOE) are different conditions with similar symptoms; heartburn/regurgitation, abdominal or chest pain and difficulty swallowing. Have you or a loved one been diagnosed with GERD or EOE?

	Yes, GERD
	Yes, EOE
	Yes, both GERD and EOE
	No

6.	Do you or a loved one suffer from any respiratory conditions that affect your/their breathing?

	Yes, I do
	Yes, a loved one
	No

7.	Do you or someone you care for suffer from age-related Macular Degeneration?

	Yes, Wet age-related Macular Degeneration
	Yes, Dry age-related Macular Degeneration
	No

8.	Have you or has someone you care for been diagnosed with Parkinson’s Disease and is experiencing, or has experienced off-time while medicated?*

	Yes, I have Parkinson's
	Yes, someone I care for has Parkinson's
	No

9.	Do you or someone close to you occasionally experience uncontrolled or involuntary movements like facial tics, movements around the mouth or rapid eye blinking? This could be a condition called Tardive Dyskinesia (TD) and can result from prolonged use of certain medications.

Yes

No

10.	Have you or someone in your family been diagnosed with Hereditary Angioedema (HAE), a rare condition characterized by recurring episodes of severe swelling?

	Yes, myself
	Yes, someone I care for
	No

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* QualityHealth.com is not affiliated with any of the listed products, brands, or merchants. This offer is an independent program for consumers. Trademarks, service marks, and/or logos (including individual product names) are the property of their respective owners, who have no association with and make no endorsement of the products and services provided by QualityHealth.com. QualityHealth.com is solely responsible for all offer fulfillment.

These promotions are brought to you by QualityHealth.com and are subject to participation terms and conditions. Receipt of an offer requires completion of the following offer terms: 1) valid age, shipping address verification, and registration on QualityHealth.com with a valid email address; 2) completion of member registration survey questions.

 Upon completion of participation requirements, we will ship the offer to you free of charge. Please allow 4 to 6 weeks for delivery. Samples are available for U.S. residents only. Limit one per household while quantities last. The product displayed may not be representative of the actual size of the offer.

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