URINAL RECEPTICAL SURVEY QUESTIONNAIRE:

• Helen J Stewart-Brooks
• Patent Pending

Summary

Female Urine Receptacle is an improved bathroom tool designed to offer a clean, portable place for women to go to the bathroom while away from home. The receptacle can be equipped with a liner and features exterior walls that can be held to urinate from a standing position.

If medically or physically, incapacitated, which item above would you use?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

If in a hospital bed and hooked up to an I-V tube, which item above would you use?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

If stuck in a traffic jam due to a shooting, or car accident with no where to relieve yourself discretely, which of the above devices would you prefer to use?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which one of the above would you consider to be spill proof with the aid of a plastic zip bag liner?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which of the above would you feel comfortable holding between your legs, standing up, rather than squatting to use?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which of the above would give you the most confidence in using if you had a quick case of diarrhea coming on?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which one of the above would be better for even males to use? 1 2 3 4 Now if You are a male filling out this survey, which of the above would you use?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which one of the above could or should be used as an emergency apparatus to be carried in trucks, campers, cars, even airplanes?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which of the above would allow you to actually hold its contents upside down and not spill with the use of a zip lock bag?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which of the above could possibly hold 3 normal urine episodes?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Which device above would you recommend especially for seniors on the go?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

For even more stability, which of the above would insure steadiness with the aid of a hands free portable stand?

Please pick a number from 1 to 4

4 Male Urinal (only usable for urine only)

3 Bed Pan (must use laying down)

2 Female Urinal (only for urine)

1 FURP360 (able to use standing up not just laying down for urine & going number 2)

Do you feel that a person with incontinence issues could benefit from the F.U.R.P 360TM device when traveling in general?

Yes or No

Yes

Would you buy one if it was in a Wal-Mart, SAM’S CLUB, or a CVS STORE, BED BATH & BEYOND at a reasonable price?

Please pick a number from 1 to 4

Yes

Lastly, would a F.U.R.P. 360TM Privacy CapeTM be beneficial having to use with one of the above devices in a less than private location, say in a stalled traffic jam?

Yes or No

Yes

Would the F.U.R.P. 360 TM POSSIBLY be a shoe-in on SHARK TANK?

Yes or No

Yes

ANY COMMENTS REGARDING THE F.U.R.P. 360TM:

THIS ENDS OUR SURVEY, THANK YOU FOR YOUR INPUT!

We appreciate you taking the time out to complete our survey!