Sample Feedback Form

Thank you for trying Hemispheres Bum Pads™. 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

Phone Number

recommendations helpful? your

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

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

Were Bum Pads™ helpful? (Please describe below)

• Yes
• No

How many Bum Pads™ did you use per day?

How often did you change Bum Pads™?

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

• Yes
• No

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

• Yes
• No
• Not applicable

Was sitting more comfortable with use of the Bum Pads™?

• 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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