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CAUTION - Investigational Device. Limited by Federal (or United States) law to investigational use.

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Eligibility Registration Form

Name

Email

Phone

City

State

Zip Code

Are you over 18 years old?

Yes No

Do you urinate 10 or more times a day?

Yes No

Do you currently have an implanted electronic device?

Yes No

Are you pregnant or plan to become pregnant during the next 12-months?

Yes No

Do you have any neurogenic bladder disorders (i.e. Multiple sclerosis, Parkinson’s, Spinal Cord Injury)?

Yes No

Have you had Botox in the bladder or pelvic floor muscles in the past nine months?

Yes No

Preferred method of contact

Email Phone

What time of day is best to contact you?

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- Am I Eligible?
- Clinical Sites
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