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      Fill out the form below to be entered to WIN a $100 Visa gift card!

      One of our Care Advisors may be in touch with you to discuss your results.

      Please note: This promotion is for catheter users only. Please only fill out this form if you or someone you know uses catheters.

      How often do you use intermittent catheters?*



      How many times a day do you currently catheterize?*







      Have you experienced a big difference in your urine output that is not due to well-known reasons?* In the last week when I catheterized...


      In the last week, when I pass urine I have noticed... (you may check one or more issues)*






      In the last 3 months I have had symptoms of a urinary tract infection...*






      The amount of occasions where these symptoms required treatment with antibiotics*






      Support Services declaration of consent

      *See contest rules and regulations here.

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