Consultants in Urology, PC

BLADDER SATISFACTION SURVEY

Which symptoms best describe you?

Have you tried medications to help your symptoms?
If yes, check the medications you have tried:
Did these medications help your symptoms? Select #
No Relief -      - Completely Cured
If you have stopped taking your medications explain why:
(i.e., caffeine intake, lifestyle changes, bladder training, pelvic floor muscle training)
What is your level of frustration with your bladder symptoms? Select #
Not Frustrated -     - Very Frustrated
If you had to live the rest of your life with these symptoms, would that be acceptable?