Study Using New Toilet Health Monitoring Device
Thank you for your interest in participating in our study
What is your first name? *
Your answer
What is your last name? *
Your answer
What is your physical address (including city)? This is where we will either install or mail your unit. *
Your answer
What are the email addresses of all regular adult users of the toilet where the device will be installed? Please enter an email address on each line. This is important for consent purposes. *
Your answer
What is your phone number? Please enter as XXX-XXX-XXXX *
Your answer
How far away is the power outlet from the toilet? *
What is the size of your toilet? Elongated, Round or Small *
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Do you or someone in your household have IBD or IBS?
Do you use an Apple (iOS) or Android mobile device? We use this information to help us as we develop a companion mobile app.
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