Application for Carin Test Panel - 2018
This is the application form for a free set of Carin to test. The data is for internal use only and will not be shared with third parties. One of your Test Team members will contact you once a set is available for you. If you have questions, please send us a message at Thanks for contacting Carin!

Test Team Carin

Email address *
What is your name?
Your answer
What is your age?
Your answer
What shipping address can we use to send a free Carin set?
Your answer
What telephone number can we reach you?
Your answer
What's your size?
How many times have you experienced giving birth?
Your answer
Have you ever experienced urine loss for more than a year after giving birth?
Have you ever practiced pelvic floor training? With either an expert or pelvic floor device?
Did you experience heart failure? (Is there a pacemaker implanted)?
I experience urine loss during the following activities:
How many years are you experiencing urine loss?
Your answer
How is stress incontinence impacting you in your daily life? How do you feel about it?
Your answer
Our Carin app is made for versions iOS 9 and later (Apple) and Android (Samsung, Sony, Huawei etc.) devices. What type of device do you have?
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms