MinaRosa Pilot Testing Interest Form

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Why Sign Up?

✨🌹MinaRosa is launching a pilot program to explore the benefits of a Class II FDA light therapy device for intimate health. We are looking for women who experience bladder discomfort, pelvic pain, or UTIs (recurrent or not) to try this non-invasive, at-home therapy and share their experiences.🌹✨

This is not a clinical trial—rather, we are gathering real-world feedback to understand how women feel using light therapy in their daily lives. Your participation will help shape the future of women’s health solutions!

If you’re interested, please fill out the form below.

‼️Please note: filling out this form does not guarantee you will take part of the pilot and all information will be strictly confidential!

What country are you located? *

Name *

Email: *

Phone Number:

📅 Age Range: *

18-24

25-34

35-44

45-54

55+

🩺 Have you struggled with UTIs, pelvic or vaginal pain, or bladder discomfort? *

Yes

Not sure, but I'm interested

🔆 Are you interested in trying a light therapy device (already approved by the FDA) as part of our pilot? (1 = Not Interested, 5 = Extremely Interested)

Clear selection

✅ Consent & Next Steps *

I understand that this is a pilot program, not a clinical study. Participation is voluntary, and this device is specifically FDA approved as Class II for muscle and joint pain relief and inflammation reduction, and not for this specific use.

Required

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