Customer Survey for 20% OFF
Thank you for your participation in our survey to gather the best and most current drink spiking statistics as we work to keep you and your drink safe! We understand and sympathize with how sensitive this topic is. In no shape or form are you obligated to complete this form. By completing and submitting this form, you acknowledge that the information given is and was completely voluntary. If you need help or want to talk to someone, please call the National Sexual Assault Hotline (1-800-656-4673).

Helpful links:
👉  Website: mycupcondom.com
👉  Product FAQs: https://mycupcondom.com/a/faq
👉  Bulk/wholesale pricing for purchase: https://mycupcondom.com/pages/wholesale 

  Always remember to practice #SafeSips with My Cup Condomâ„¢
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Full Name (if anonymous is preferred, please type "Anonymous") *
Email *
What is your gender? *
Age *
Has your drink ever been drugged/spiked without your knowledge/consent? *
Have you been sexually assaulted as a result of drink spiking? *
Do you know anyone who has been "roofied" or affected by drink spiking? *
Do you know someone who lost their life due to drink spiking? *
Have you ever been worried of your drink being spiked without your knowledge/consent? *
On a scale of 1-5, how worried are you that your drink may be spiked when using an open container at a party/bar/club/etc.? *
Never worried
Always worried
Have you ever stayed in due to fear of your drink being spiked with drugs? *
Do you actively watch your drink when out at a party/bar/club/etc.? *
Do you believe drink spiking is an issue in our society? *
Do you often spill your drink at a party/bar/club? *
Have you ever had a drink spilled on you at a party/bar/club? *
How much of your drink do you usually lose when dancing or moving around at a party/bar/club? *
Would you use My Cup Condomâ„¢ on your drink to protect it from unwanted contaminants and spillage? *
What country/region are you located in? *
Are you interested in our Safe Sipperâ„¢ Brand Ambassador Program? *
Are you a survivor of drink spiking and want to share your story (can be shared anonymously) to grow awareness about the issue? *
Anything else you want us to know?
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