BPH Study Pre Survey

Please fill out this form completely for our BPH Therapy Study.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

The International Prostate Symptom Score (IPSS) questionnaire was developed to measure the severity of your BPH symptoms. Your score is not meant to provide medical advice or replace your doctor’s expert opinion and care. Only your doctor can diagnose whether you have BPH and assess your individual condition. There are other conditions that can cause urinary symptoms besides BPH.

The following is a series of questions that ask how often certain symptoms occur. To mark your response, click on the box that best describes your symptoms.

Incomplete Emptying

1 – Over the last month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? *

Frequency

2 – During the last month, how often have you had to urinate again less than 2 hours after you finished urinating? *

Intermittency

3 – During the last month, how often have you found you stopped and started again several times when you urinated? *

Urgency

4 – During the last month, how often have you found it difficult to postpone urination? *

Weak Stream

5 – During the last month, how often have you had a weak urinary stream? *

Straining

6 – During the last month, how often have you had to push or strain to begin urination? *

Sleeping

7 – During the last month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? *

Quality of Life

8 – If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? *

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All Resona Health products are FDA general wellness devices. We do NOT treat, diagnose, prevent, or cure any disease nor do we make ANY claims in this manner.