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
Cannot pre-fill email address.
What is your name?
What is your age?
What shipping address can we use to send a free Carin set?
What telephone number can we reach you?
What's your size?
How many times have you experienced giving birth?
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?
Yes, with a physiotherapist
Yes, with a pelvic floor device (kegel exerciser / electronic stimulation etc.
Yes, I had pelvic floor surgery
Did you experience heart failure? (Is there a pacemaker implanted)?
I experience urine loss during the following activities:
Sports (or during any types of physical activities such as hiking, cycling etc.)
'Spontaneous' moments such as sneezing, laughing out loud, coughing)
How many years are you experiencing urine loss?
How is stress incontinence impacting you in your daily life? How do you feel about it?
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?
Android 4.4 (KitKat) and higher
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