Quiz

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Fill out the quiz below and we will be in touch to support you

We are here to help veterans and caregivers navigate urinary incontinence with confidence and compassion. Take our short quiz, and we’ll connect you with solutions that bring comfort and dignity.

First, please identify yourself

Please identify yourself for us: are you a veteran or a caregiver of a veteran?
We’d love to know more about you so we can better support your needs.

I'm a veteran

I'm a caregiver

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1 / 6

Which branch did you or your loved one serve in?

Please select the branch where you or your loved one served: Army, Marine Corps, Navy,
Air Force, Space Force, or Coast Guard

ArmyMarine CorpsNavy

Air ForceSpace ForceCoast Guard

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Which of the following are you
currently experiencing?

Urinary incontinence (accidental loss of urine)Urinary retention (difficulty emptying all the urine from your bladder)

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3 / 6

What product(s) do you most often use to help manage your urinary incontinence?

Adult diapers or briefsProtective underwearDisposable padsI'm not using anything

4 / 6

Eligibility Quiz

How frequently do you change your current product(s) in a 24-hour period?

2 changes or lessMore than 2 changesNot sure

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5 / 6

What are your concerns with managing urinary incontinence?

Please select all that apply

Fall risks from nighttime bathroom visitsInterruption of sleepMultiple changes of bed linens

Moisture-related skin damageOtherI don't have any concerns

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6 / 6

Confirm Submission.

Thanks for taking the time to complete this form.
Please enter your email below and we will be in contact within 24 hours.

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What's your best contact email?

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