SugarMDs Customer Response Form

Recalled Product: Advanced Glucose Support Supplement (60, 120, 180 Capsule Counts)

Lot Number: 22165-003

Recall Date: November 29, 2023

Full Name* Email Address* Phone Number Mailing Address* Date of Purchase (if known) Where did you purchase the product?* Which size(s) did you purchase?*

60 Count

120 Count

180 Count

How many bottles did you purchase?* Did you experience any adverse reactions after taking Advanced Glucose Support?*

Yes No

If yes, please explain what adverse reactions you experienced:

Were you notified about the recall on Advanced Glucose Support? Upload a photo of the bottle label or receipt (optional) Do you intend to return the product? Additional Comments