Do you leak urine when you cough, sneeze, or laugh?
Yes
No
Do you leak urine when you exercise?
Yes
No
Do you feel pressure, heaviness, or a “falling out” sensation in your pelvis?
Yes
No
Do you go to the bathroom “just in case” frequently?
Yes
No
Do you feel a strong urge to urinate or have a bowel movement and need to rush to the bathroom?
Yes
No
Do you often feel like you didn't fully empty your bladder or bowels?
Yes
No
Do you experience pain with intercourse or inserting a tampon?
Yes
No
Do you have low back, hip, or pelvic pain that hasn’t fully resolved?
Yes
No
Did you have tearing, a C-section, or complications during delivery?
Yes
No
I don't have kids
Do you avoid certain exercises (running, jumping, lifting) because of discomfort or symptoms?
Yes
No
Do you feel disconnected from your core or unsure how to properly engage it?
Yes
No
Do you ever feel like “something just isn’t right” in your body, even if you can’t explain it?
Yes
No
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