1. Incomplete Emptying Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating? Choose answerNot At AllLess Than 1 Time In 5Less Than Half The TimeAbout Half The TimeMore Than Half The TimeAlmost Always 2. Frequency Over the past month, how often have you had to urinate again less than two hours after you have finished urinating? Choose answerNot At AllLess Than 1 Time In 5Less Than Half The TimeAbout Half The TimeMore Than Half The TimeAlmost Always 3. Intermittency Over the past month, how often have you found you stopped and started again several times when you urinated? Choose answerNot At AllLess Than 1 Time In 5Less Than Half The TimeAbout Half The TimeMore Than Half The TimeAlmost Always 4. Urgency Over the past month, how often have you found it difficult to postpone urination? Choose answerNot At AllLess Than 1 Time In 5Less Than Half The TimeAbout Half The TimeMore Than Half The TimeAlmost Always 5. Weak Stream Over the last month, how often have you had a weak urinary stream? Choose answerNot At AllLess Than 1 Time In 5Less Than Half The TimeAbout Half The TimeMore Than Half The TimeAlmost Always 6. Straining Over the past month, how often have you had to push or strain to begin urination? Choose answerNot At AllLess Than 1 Time In 5Less Than Half The TimeAbout Half The TimeMore Than Half The TimeAlmost Always 7. Nocturia Over the past month how many times did you most typically get up each night to urinate from the time you went to bed until the time you got up in the morning? Choose answerNoneOnceTwice3 times4 times5 or more Quality of Life due to Urinary Symptoms If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? Choose answerDelightedPleasedMostly satisfiedMixedMostly unhappyUnhappyTerrible First name (required) Last name (required) Your email address (required) Phone Number (required)
