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Please provide us with your full name and email address.

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Have you experienced urine leakage with coughing, sneezing, exercise, etc.?

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Have you experienced increased urgency and/or frequency of urination?

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Have you experienced urine or fecal leakage due to inability to make it to the bathroom in time?

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Does the problem affect your function or social life (e.g. sports, home life, relationships, etc.?)

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Have you tried other treatment options (drugs, exercise, surgery, etc.) without full recovery?

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Would you like some help with your current situation?

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