Sample Feedback Form

Thank you for trying Hemispheres® BumPads™. Please describe your experience in detail. The more information you provide, the sooner this product will become commercially available!

Thank you for trying our product and generously providing feedback.

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Your Name

Email Address

BumPads™? being Did

Phone Number

What were your reasons for using Hemispheres® BumPads™ (select all that apply)?

• Hemorrhoids
• Excessive Sweating
• Fecal Soiling/Leakage
• Need to Change Underwear
• Other (please describe):

Were BumPads™ helpful? (Please describe below)

• Yes
• No

How many BumPads™ did you use per day?

How often did you change BumPads™?

Did you ever use more than 1 BumPad™ at a time (that is, did you stack them)?

• Yes
• No

Did using the BumPad™ give you more confidence being in public?

• Yes
• No
• Not applicable

Was sitting more comfortable with use of the BumPads™?

• Yes
• No
• Not applicable

If you had an odor problem, did it improve?

• Yes
• No
• Not applicable

Please provide any recommendations to improve the product.

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