Women’s Health Screening Test

Are you in need of our Women’s Health Services?  You may be surprised when you stop and think about it.  Take our screening test to find out.

1. Do you have urine leakage when coughing, laughing, sneezing, or lifting something heavy?

 
 

2. Do you have urine leakage associated with urgency?

 
 

3. Do you have difficulty or incomplete emptying of bladder? Rectum?

 
 

4. Do you wake up more than twice/night to urinate?

 
 

5. Do you have a feeling of fullness in vaginal area? Rectum?

 
 

6. Do you have straining or pain with bowel movements? Chronic constipation?

 
 

7. Do you have stool leakage of any kind?

 
 

8. Do you have urgency associated with bowel movements?

 
 

9. Do you have involuntary loss of gas?

 
 

10. Has loss of bladder or bowel control affected your quality of life?

 
 

11. Do you have pain with intercourse or when sitting?

 
 

12. Do you have chronic pelvic pain?

 
 

13. Your Name

14. Your Email