UniSUC Customer Survey UniSUC Customer Survey Demographic Questions: Are you an End User or a Caregiver? SelectEnd UserCaregiver User Age <60 years 61 – 70 years 71 – 80 years 80+ years User Biological Gender SelectFemaleMale User Mobility Level SelectImmobileLimited mobilityFull mobility User’s Usage Needs Day Night Check all that apply User duration of use < 1 month 1 to 3 months 3 to 6 months 6 months + Which of these products have you used prior to UniSUC? Diapers alone Protective underwear Medication PureWick Condom Catheter PrimaFit/PrimoFit Foley Catheter Surgery Select all that apply Please compare the various catheters if you have experience with them: General Satisfaction UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied How would you rate your comfort? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimaFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied What was the level of your dryness by the end of use? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Did the device save you time? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Was the device cost efficient/effective? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Did the device improve sleep? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Is the device easy to set up? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Is the device easy to use? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfiedd Does the device help your dignity? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Did the device reduce urine infections? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Fewer nighttime bathroom trips? UniSUC 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Diapers alone 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PureWick 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Condom Catheter 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied PrimaFit/PrimoFit 1 2 3 4 5 1 = Very Unsatisfied, 5 = Very Satisfied Specifically for UniSUC, how likely would you do the following? Will you continue using UniSUC? 1 2 3 4 5 1 = Very Unlikely, 5 = Very Likely Would you recommend UniSuc to a friend? 1 2 3 4 5 1 = Very Unlikely, 5 = Very Likely If you have any other comments or feedback you’d like to share, please enter it here: 0 of 1000 max characters Submit Start Over If you are human, leave this field blank. Δ
