Schedule a Consultation
561-701-2841
Palm Beach Gardens & Boynton Beach
Click for Locations

Urinary Leakage Questionnaire

 

questionaire

click on image to see at full size

Scoring:

Each item scores 0 (None of the time), 1 (Rarely), 2 (Once in a while), 3 (Often), 4 (Most of the time) or 5 (All of the time). Responses to items 1, 2 and 3 are summed for the Stress score, and responses to items 4, 5 and 6 are summed for the Urge score.

Print Friendly, PDF & Email