Full Name
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Address
Date of birth
How often have you had the sensation of not emptying your bladder?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
No elements found. Consider changing the search query.
List is empty.
How often have you had to urinate again less than 2 hours after you finished urinating?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
No elements found. Consider changing the search query.
List is empty.
How often have you found you stopped and started again several times when you urinated?
*
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
No elements found. Consider changing the search query.
List is empty.
How often have you found it difficult to postpone urination?
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
No elements found. Consider changing the search query.
List is empty.
How often have you had a weak urinary stream?
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
No elements found. Consider changing the search query.
List is empty.
How often have you had to push or strain to begin urination?
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
No elements found. Consider changing the search query.
List is empty.
How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
Not at all (0 points)
Less than 1 time in 5 (1 point)
Less than half the time (2 points)
About half the time (3 points)
More than half the time (4 points)
Almost always (5 points)
No elements found. Consider changing the search query.
List is empty.
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