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Dilators
Pelvic Wands
Kegel Weights
More Products
Lubricants
Supplements
Bundle Deals
All Products
Guides
Find Your Solution
How To Use Kegel Weights
Kegel Exercises
Using Vaginal Dilators
Pelvic Floor Release
Videos
Blog
FAQ
Community & Mission
Real Women / Real Stories
Find a Provider
Clinician Portal
Clinician Samples
Clinician Courses
Dr Amanda Bio
Our Mission
Lubricants
Supplements
Bundle Deals
All Products
Find Your Solution
How To Use Kegel Weights
Kegel Exercises
Using Vaginal Dilators
Pelvic Floor Release
Videos
Blog
FAQ
Real Women / Real Stories
Find a Provider
Clinician Portal
Clinician Samples
Clinician Courses
Dr Amanda Bio
Our Mission
PHN Samples Request Form
WOMEN'S HEALTH CLINICIANS:
Application for Samples
*
indicates required
*
My PRIMARY Occupation is...
Student
Physical Therapist
Occupational Therapist
Nurse, NP, or CNM
Doctor
Educator
Other
*
How long have you been aware of Intimate Rose products?
0-3 months
4-6 months
6-12 months
1 Year or more
*
Where did you FIRST hear about Intimate Rose?
APTA CSM
APTA Menopause Course
APTA Pelvic Health Level 1
APTA Pelvic Health Level 2
Herman & Wallace Course
ISSWSH
Other Conference
Amazon
Google
Social Media
Other
*
In an average month, how many NEW female patients with URINARY INCONTINENCE do you see?
0
1-2
3-6
7-10
10-15
16+
*
In an average month, how often do you recommend pelvic floor weights (vaginal weights) to your patients:
I've never recommended vaginal weights
0-1
2-4
5-8
9+
*
In an average month, how many NEW female patients with PELVIC PAIN you see?
0
1-2
3-6
7-10
10-15
16+
*
In an average month, how many times do you recommend VAGINAL DILATORS to a patient?
I've never recommended dilators
0-1
2-4
5-8
9+
Do you typically recommend a specific brand of vaginal dilators/trainers? Which brand and why?
*
In an average month, how many times do you recommend a Pelvic Trigger Point Wand to a patient?
I've never recommended pelvic trigger point wands
0-1
2-4
5-8
9+
*
In average month, how many times do you recommend a vulvar balm (or coconut oil) for vulvar dryness and irritation?
I've never recommended vulvar balms
0-1
2-4
5-8
9+
*
If you like our products, would you be interested in selling Intimate Rose products in your clinic?
yes
no
Sometimes when shipping to hospitals or clinics, our samples get lost in their mail system. Please confirm the address below at which you can receive shipments:
*
Clinic / Hospital Name
*
First Name
*
Last Name
*
Phone Number
*
Address
Address
*
City
*
State
*
Zip
*
Email Address
What else should we know about you and your practice?
Website
Submit My Sample Request.
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