If you would like product samples and additional information at no charge or obligation, kindly complete the following form.
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The person experiencing bladder/bowel loss is:
Male
Female
For urinary loss, how would you evaluate the condition:
Light to Moderate (up to 8 ounces)
Moderate to Heavy (9 to 15 ounces)
More (over 15 ounces)
For full bladder and/or bowel protection, please indicate waist size for sample selection:
Youth (15-22")
Small (20-31")
Medium (32-44")
Large (45-58")
Extra-Large (59-64")
XXL (63-68")
XXXL (68 - 92")
How did you hear about Dignity Products?
Drug Store
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Check this box if you would like the name of a local store or dealer who sells our products.
Your questions and comments are are welcomed and appreciated:
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Humanicare International, Inc.4265 West Vernal Pike, Bloomington, IN 47404 • USAPhone: 1-800-631-5270 Fax: 1-888-676-8080
