Mute Mouth Tape Trial Thank you for agreeing to take part in our trial. Before we ask you to try our new mouth tape, we need to make sure that the product is suitable for you. Name(Required) First Last Email(Required) Enter Email Confirm Email Do you have difficulty breathing through your nose?(Required) Yes No Do you use a nasal dilator or nasal strips?(Required) Yes No Are you considered obese? Is your Body Mass Index over 35?(Required) Yes No Don’t know Do you have very low blood pressure?(Required) Yes No Don’t know Do you have severe heart or breathing problems?(Required) Yes No Have you been diagnosed with sleep apnoea?(Required) Yes No Thank you for offering to take part in our survey. Unfortunately, your responses indicate that the mouth tape may not be suitable for you due to one of the contraindications specified for all mouth tape products. Great. You qualify for this trial. Please fill out your details below.Phone(Required)Age(Required) 18-24 25-34 35-44 45-54 55-64 65+ Gender(Required) Female Male Other Address(Required) Street Address Address Line 2 City ACTNSWNTQLDSATASVICWA State Postcode Preferred Mute size Trial Pack Small Medium Large
