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Customer Satisfaction Survey

Please complete the following survey and let us know about your experience with uresta^®

1. Country you are located

2. Condition

3. Do you have any history of a previous vaginal surgery?

Yes No

4. If you answered yes to Question 3, was the surgery within the last year?

Yes No

5. Were you able to find a comfortable fit with the uresta® device?

Yes No

6. If no, can you please detail what you found uncomfortable?

7. Were or are you still using the uresta® device 2 weeks after your first use?

Yes No

8. If no, what was the reason why you stopped using the device?

9. If you answered yes to question 7, how long have you been using the uresta® device?

10. Do you intend to continue using uresta®?

Yes No

11. If you stopped using uresta®, what was the reason?

12. If you have used or are using uresta® for more than 6 months, how does the device look? Please check if any of the following are applicable.

Cracking Pieces missing Change in shape Color changes or fading No signs of damage or deterioration

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