* Required Fields - All fields are required except Fax number.

* Model Number:

* Serial Number:

* Purchase Date:
(eg: 01/10/2000)

* Delivery Date:

* Dealer Name:

* First Name:

* Last Name:

* Street Address:

* City:

  * State:    * Zip:

* Phone:

  Fax:

* E-mail Address:

• Optional Fields
Please answer the questions below for us to better serve you and to improve customer care

What is the primary reason you purchased Healthmate (e.g. detoxification, weight loss, arthritis, relaxation)?

How long did it take for you to make up your mind to purchase Health Mate after your first inquiry?

What was the greatest influence on your decision to purchase Health Mate (e.g. friend's recommendation)?

Where are you planning on setting up your Healthmate (e.g. bedroom, personal gyms, bathroom, patio)?

Please tell us about your hobbies and interests(e.g. jogging, gardening, day spa, cooking)?

Your Primary Residence:

Your Age Group:

Not including yourself, what are the ages of the other people living in your household?

Male (age in years):

Female (age in years):

Family Income:

Your Education:

Your Profession:

What areas of your health or beauty are you most concerned about?

What are you currently doing to improve your overall health or beauty (e.g. exercise, herbal medicine, aromatherapy)?

What magazines or publications do you subscribe to?

THANK YOU FOR TAKING YOUR TIME TO FILL OUT THE ABOVE INFORMATION. PLEASE DOUBLE CHECK ALL ENTRIES BEFORE SUBMITTING. THE INFORMATION YOU'VE PROVIDED IS ESSENTIAL TO THE WARRANTY REGISTRATION PROCEDURE.