Incontinence Survey Question Title * 1. 1. What is your age or the age of the loved one who is incontinent (includes children who have not been potty trained due to disablility) 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 26 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 Other type age here OK Question Title * 2. 2. If you or your loved one are incontinent, how would you describe the level of incontinence? Light Moderate Moderate to Heavy Heavy Severe/Total OK Question Title * 3. Do you use absorbent products (ie adult briefs, aka diapers or similar products) to manage? Never Sometimes Often Always OK Question Title * 4. Are you or your loved one on Medicaid or other insurance that sometimes provides incontinence supplies ? Yes No OK Question Title * 5. If yes to number 4, do you receive incontinence products from Medicaid or another insurance provider Yes No OK Question Title * 6. If yes to the above, what state do you reside in? OK Question Title * 7. If yes to number 5, what brands and styles do you recieve? OK Question Title * 8. If you answered yes to number 5, do you feel that the products you receive are the best you could receive to help you or your loved one manage incontinence effectively (i.e. Keep skin dry, help maintain active lifestyle, confidence and security from leaks, able to go about daily life without changing excessively) In other words, how satisfied are you with the products you currently receive? Not satisfied Somewhat satisfied Satisfied Mostly satisfied Completely satisfied OK Question Title * 9. If you answered no to question 5, what is the average monthly cost of your or your loved one's incontinence products? What Brands do you use? Do you feel you are able to afford adequate supplies? Why or why not OK Question Title * 10. If there were an organization dedicated to helping those in need get the highest quality incontinence supplies for youth teen and adults, in addition to providing diapers to special needs infants and toddlers and providing funding for catheters for the uninsured or under insured, would this be helpful? Why or Why not? OK DONE