Diem Pouch - Early Adopter Program
Thank you for your interest in Diem Pouch.
We're selecting a small group of early product testers.
If chosen, you'll receive a free smart pouch and be part of the movement!
Apply now
 
What's your first name? *

 
What's your last name?

 
What's your age? *

 
What's your current e-mail address? *

No spam will be e-mailed to you.
 
What is your current physical mailing address? *

This is so we can send you a free Pillsy smart pill pouch via mail.
No spam will be mailed to you. Please provide your full address.
Example: 123 Yonge Street, Toronto, ON, M5S2E8, Canada
 
What kind of smartphone do you currently use? *


 
What's your current BC Pill brand, type, DIN/NDC? *

Example: Pfizer, Alesse 21, DIN 02236974
 
Describe the form factor of your pill pack, including approximate dimensions. *

Example: 4 rows of 7 pills in thin strip blister pack with dimensions of 5cm x 8cm.
 
What is one thing you find most difficult about taking birth control pills?

 
Any questions for us?

 
Your information will be kept confidential and only used for product mailing and feedback purposes.

Thanks for applying.
We'll get back to you soon!
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