Me Luna Advisory Service

Order Number *

Online shop www.me-luna.com

Your name *

Your age *

(Select entry) 12 to 19 years old 20 to 25 years old 26 to 30 years old 31 to 39 years old 40 to 45 years old Over 46 years old

Did you have vaginal births *

(Select entry) No Yes, one vaginal delivery Yes, two vaginal deliveries Yes, three or more vaginal deliveries

Did you deliver by section *

(Select entry) No Yes, one section Yes, two section Ja, three or more sections

Enter your height (in cm) *

Enter your weight (in kg) *

Are you still a virgin *

No Yes

Your Fitness level *

(Select entry) Normal fitness level. No special training, but regular exercise. I'm athletic, exercise regularly. (Please be more specific in the text box) I have little exercise, possibly restricted mobility.

What kind of sport

Uterine prolapse *

No (not known) Yes, it was diagnosed.

If yes, please specify

Your menstrual flow is *

(Select entry) Very light flow all days Light flow to normal. Normal (2 days more) Sometimes heavy menstrual flow Generally heavy menstrual flow Always very heavy menstrual flow

Do you use tampons *

Yes No

If so, what size

If not, why not

Special features of tampon usage

Please let us know if tampons slip, cause pain, do not seal or there are length problems.

How often do you change *

Tampons Sanitary napkins Cup

on your stronger days in 24 hours *

Do you have experience with a cup *

Yes No

If yes, please fill in the next fields as precisely as possible:

Brand of the cup

Size of the cup

Softness of the cup

Specified only if your brand offers different degrees of softness, e.g. Me Luna (see inner edge cup)

Since when do you wear the cup

How do you assess the diameter of the size used

(Select entry) No problems. I think it's too big. Too small. The cup slips out.

How do you rate the length of the size used

(Select entry) I can insert the cup deep enough. Too long. The cup can not be fully inserted. Too short. It was too deep inside.

Describe your experience as accurately as possible

Your email address *

I agree that Me Luna processes my data for the purpose of processing my request and contacts me. Submitting the form confirms that the sender is at least 16 years old. Information about the contact form can also be found in our privacy policy. Your data will be encrypted, kept confidential and will not be disclosed to third parties. *

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