Apply for the 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 hi@carinwear.com. 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? Please include street address, city, state, zip code, and country. *
Your answer
What telephone number can we reach you at? *
Your answer
What is your size? *
How many times have you given 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 ever experience heart failure? (Do you have an implanted pacemaker)? *
I experience urine loss during the following activities: *
Required
How many years have you been experiencing urine loss? *
Your answer
How does stress incontinence impact 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? *
Did we miss something? Please share with us any additional comments. *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms