Name:

Email: *

Are you exploring an alternative treatment to surgery or another recommended procedure for your benign prostatic hyperplasia? *

Yes

No

During the past month, have you experienced any of the following? (Check all that apply.) *

(Check all that apply.)

• Difficulty fully emptying your bladder
• Frequent urination during the day (sometimes more than once within a 2-hour period)
• Have to get out of bed to urinate at night
• Weak urine stream
• Have to push or strain to start urinating
• No elements found. Consider changing the search query.
• List is empty.

How often do you have a sensation of not emptying your bladder completely after you finished urinating?

Select One

• Not at all
• Less than 1 time in 5
• Less than half the time
• About half the time
• More than half the time
• Almost always
• 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?

Select One

• Not at all
• Less than 1 time in 5
• Less than half the time
• About half the time
• More than half the time
• Almost always
• No elements found. Consider changing the search query.
• List is empty.

Phone: *

Any Other Additional Relevant Information?

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