nighttime-form – Best Mart

Anonymous Wellness Survey

Your responses help us understand and support you better

1 Which age group best describes you (or the person you care for)?*

Under 6 6–12 13–18 19–30 31+

2 Who does this survey relate to?*

Myself My child Someone I care for

3 How often do nighttime accidents happen?*

Every night 3–5 times a week A few times in a month

4 How long has this been happening?*

Less than 6 months 6–12 months 1–3 years Over 3 years

5 How does this situation make you (or the person you care for) feel most time?*

Select all that apply

Embarrassed Anxious Frustrated Helpless Tired Hopeful it will improve I try not to think about it

6 What worries you the most about this issue?*

Select all that apply

Smell/cleanliness Being discovered Child's confidence Marriage/relationships Health concerns Cost of managing it

7 What have you tried so far?*

Select all that apply

Doctor/hospital Herbal remedies

What type of herbal remedy did you try? (Optional)

Liquid Powder Pills

Limiting water at night Waking up at night Nothing yet

8 What has stopped you from getting a lasting solution?*

Select all that apply

Cost Shame/privacy Fear it won't work Didn't know what to do Cultural beliefs

9 If this problem stopped completely, what would change most for you?*

Select all that apply

Better sleep Peace of mind Confidence Family harmony Less stress

10 If a lasting solution is developed, would you love to try it?*

Yes No

11 Would you like us to contact you to try the product?*

Yes No

12 If you chose yes in any of the last 2 questions, how would you like us to contact you?

Optional - Select your preferred contact method and provide details

Email Phone Number

Email Address (Optional):

Phone Number (Optional):

Your Privacy Matters: All responses are anonymous and confidential. This survey is for research purposes only and does not replace medical advice.

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