Mailchimp Survey

Expression of Interest - Autism GI Support Educational Program

Please confirm you meet the following criteria:
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My child has an Autism Spectrum Disorder diagnosis (not including Rett Syndrome)
My child has some gastrointestinal issues / discomfort / difficulties.
My child is under the age of 18.
My child is capable of, and old enough to safely swallow probiotic pills. (Powdered capsules can be opened and mixed into food or beverage (not hot), and the oil matrix capsule can be cut into smaller pieces).
I am willing/able to purchase 6 months of ProTren probiotics for my child at a 40% discount. (Do not need to be purchased all at once)
I am willing to engage on the topic of proper nutrition, and explore nutritional changes with my child.
I am willing to participate in educational sessions with a member of the ProTren Autism Team to discuss GI health, proper nutrition, and customization of probiotic supplements.
First Name:
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Last Name:
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Email:
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Cell:
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Mailing Address (you must be in the USA to participate):
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Name of Child:
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Date of Birth of Child:
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Type of ASD Diagnosis:
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Age of ASD Diagnosis:
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Any other formal diagnosis child has received:
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Any prescription medications your child is currently taking:
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Is your child currently taking a specific probiotic recommended by your doctor? If so, which probiotic was recommended?
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Has your child taken a yeast based or soil based probiotic in the last 12 months?
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Please briefly outline any gastrointestinal concerns you have about your child:
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How did you hear about us?
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I have read the terms, conditions, information and disclaimers below:
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The educational talks, videos, literature and chats with the Autism Team are not intended to diagnose, treat, cure, or prevent any disease. The educational information on the website and the educational conversations, educational video live chats, and educational phone calls are for general information. The information is not advice, and should not be treated as such. These products are not intended to diagnose, treat, cure or prevent any disease. If you have any specific questions about any medical matter, you should consult your own doctor or your own professional healthcare provider. If you think you or your child may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on the website or educational calls.
The Autism GI Support Program, and all the content published on this website, and any associated social media pages or applications (collectively, the “Website”), are for informational and educational purposes only and are not in any circumstance to be interpreted or treated as qualified medical advice or a consultation or diagnosis of a health care practitioner. Participation and/or use of the Autism GI Support Program and all of the content published on the Website do not constitute a basis for self-diagnosis, individual treatment or a treatment of any persons based on information obtained through this Website or Program. Any information obtained using the Website or Program, including any results of questionnaires, is not deemed to be health care services and is not meant to be a substitute for an appointment, medical diagnosis, or any form of consultation with a health care practitioner. If you are experiencing any conditions or symptoms, you should contact your health care practitioner for assistance. Natren, Inc., ProTren Probiotics International, LLC, the Global Institute of Probiotics, Autism Team educator or contractor assumes no liability for any diagnosis, treatment, decision made, or action taken or not taken in reliance upon information provided on the Website or any other sites linked to or from the Website in any way, or the Autism GI Support Educational Program including educational sessions. Natren, Inc., ProTren Probiotics International, LLC, the Global Institute of Probiotics, Autism Team educator or contractor does not assume any responsibility or risk for your use of the Website or related Natren or ProTren sites. THE WEBSITE IS PROVIDED "AS IS" AND "AS AVAILABLE" WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED. NATREN, INC. OR PROTREN DISCLAIMS ALL EXPRESS AND IMPLIED WARRANTIES WITH REGARD TO THE WEBSITE AND ALL MATERIALS, INFORMATION, SOFTWARE, PRODUCTS, TOOLS, AND SERVICES INCLUDED IN OR AVAILABLE THROUGH THE WEBSITE, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT. YOUR USE OF THE WEBSITE IS AT YOUR OWN RISK. ACCESS TO THE WEBSITE MAY BE INTERRUPTED AND THE MATERIALS, INFORMATION, SOFTWARE, PRODUCTS, TOOLS, AND SERVICES INCLUDED IN OR AVAILABLE THROUGH THE WEBSITE MAY NOT BE ERROR-FREE. NONE OF NATREN OR PROTREN, INC, ITS SUPPLIERS, OR ANYONE ELSE INVOLVED IN CREATING, PRODUCING, OR DELIVERING THE WEBSITE OR THE MATERIALS, INFORMATION, SOFTWARE, PRODUCTS, TOOLS, AND SERVICES INCLUDED IN OR AVAILABLE THROUGH THE WEBSITE WARRANTS THAT THE MATERIALS, INFORMATION, SOFTWARE, PRODUCTS, TOOLS, AND SERVICES INCLUDED IN OR AVAILABLE THROUGH THE ONLINE SERVICES ARE ACCURATE, RELIABLE, COMPLETE, USEFUL, OR CORRECT; THAT THE WEBSITE WILL BE AVAILABLE AT ANY PARTICULAR TIME OR LOCATION; THAT ANY DEFECTS OR ERRORS WILL BE CORRECTED; OR THAT THE WEBSITE IS FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. SOME JURISDICTIONS MAY NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES, SO SOME OF THE ABOVE EXCLUSIONS MAY NOT APPLY TO YOU. CHECK YOUR LOCAL LAWS FOR ANY RESTRICTIONS OR LIMITATIONS REGARDING THE EXCLUSION OF IMPLIED WARRANTIES. UNDER NO CIRCUMSTANCES SHALL NATREN, INC. OR PROTREN OR ITS EMPLOYEES, OWNERS, EXECUTIVES, SUPPLIERS, OR CONTRACTORS BE LIABLE FOR ANY DIRECT, INDIRECT, PUNITIVE, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES OF ANY KIND, INCLUDING LOSS OF DATA, ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE USE OF, OR INABILITY TO USE, THE WEBSITE. THIS LIMITATION APPLIES WHETHER THE ALLEGED LIABILITY IS BASED ON CONTRACT, TORT, NEGLIGENCE, STRICT LIABILITY, OR OTHER LEGAL THEORY, EVEN IF NATREN, INC.OR PROTREN HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. IN THE EVENT SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF DAMAGES TO THE EXTENT INDICATED ABOVE, NATREN, INC’S OR PROTREN’S IN SUCH JURISDICTIONS SHALL BE LIMITED TO THE EXTENT PERMITTED BY LAW. YOU ACKNOWLEDGE AND AGREE THAT THE LIMITATIONS SET FORTH ABOVE ARE FUNDAMENTAL ELEMENTS OF THIS AGREEMENT AND THE WEBSITE WOULD NOT BE PROVIDED TO YOU ABSENT SUCH LIMITATIONS.

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