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Claim your free sample below!
Please take a moment to complete the following survey to receive a coupon for a FREE sample!
Please be assured that we will not disclose any information about you and this form is for event registration purposes only.
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Email
*
Your email
1. Who are you ordering this trial for?
*
Myself
My Spouse/Partner
Parent/Loved One
2. What is the gender of the person who will be using the samples in this trial kit?
*
Male
Female
3. Age of users
*
under 18
18-24
25-34
35-44
45-54
55-64
65+
4. Absorption selection
*
Light to moderate leakage proof （7.0 oz）
Severe leakage proof （10.0 oz）
Other:
Required
5. How did incontinence happen
*
Prostate problem
Diabetes
After giving birth
Neurological disease(e.g. multiple sclerosis, Parkinson’s disease, Alzheimer's disease, cerebral palsy, stroke, head injury …)
Other:
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