PHN Samples Request Form

My PRIMARY Occupation is...

NTH How long have you been aware of the Intimate Rose Kegel Exercise System?

Where did you FIRST hear about Intimate Rose

In an average week, how many NEW female patients with URINARY INCONTINENCE do you see?

In an average week, how many times do you recommend STANDARD Kegel Exercises to your patients

Of the patients you've recommended vaginal weights to, what percentage followed through with purchase?

In an average week, how many NEW female patients with PELVIC PAIN you see?

In an average week, how many times do you recommend VAGINAL DILATORS to a patient?

Would you recommend Intimate Rose dilators if they are higher quality but more expensive than other brands?

In an average week, how many times do you recommend a Pelvic Trigger Point Wand to a patient?

Would you recommend the Intimate Rose pelvic trigger point wand if it COST MORE but is MORE COMFORTABLE and had the OPTION TO VIBRATE?

In an average week, how many times do you recommend an organic VAGINAL BALM such as V-MAGIC to your patients?

If you like our products, would you be interested in selling Intimate Rose products in your clinic?

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:

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Click "Submit" to finish your request.

PHN Samples Request Form

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