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Name

Phone Number

Have you used collagen before?

If so, what brand?

What are your current skin/ beauty/ hair concerns? And why you think Revive could assist.

Tell us why you want to join a trial? Please include information such as lifestyle, past health issues and current concerns.

Are you pregnant or breastfeeding?

Do you have an active or sedentary lifestyle?

Do you have any health concerns?

Tell us about your current diet

Please be sure to email us images of your current skin and hair on info@therevivelab.com