What is your teens gender?

  Male
  Female

Does your teen use a mattress protector?

  Yes
  No

How old is your teen?

  11-14
  15-17
  18+

When was this?

  Now
  Earlier
  Last night
  Other

How much did your teen pee? Skip if your teen has a mattress protector.

  Large Patch
  Big Patch
  Medium Patch
  Small Patch
  Skip (Mattress Protector)

When was the last time your teen wet the bed?

  When was younger.
  Months ago
  Weeks ago
  Days ago
  Last night
  Never

How does your teen feel about it?

  Happy
  Embarrassed
  Sad
  Scared
  None

Who are you?

  Parent
  Guardian
  Other

What do you think your child needs?

  High Level Protection
  Medium Level Protection
  Low Level Protection

Are you ready for the results?

  Yes
  No