Urinary Incontinence Screening Quiz Please provide us with your full name and email address. Question Title Please provide us with your full name and email address. Name Email Address Have you experienced urine leakage with coughing, sneezing, exercise, etc.? Question Title Have you experienced urine leakage with coughing, sneezing, exercise, etc.? Yes No Have you experienced increased urgency and/or frequency of urination? Question Title Have you experienced increased urgency and/or frequency of urination? Yes No Have you experienced urine or fecal leakage due to inability to make it to the bathroom in time? Question Title Have you experienced urine or fecal leakage due to inability to make it to the bathroom in time? Yes No Does the problem affect your function or social life (e.g. sports, home life, relationships, etc.?) Question Title Does the problem affect your function or social life (e.g. sports, home life, relationships, etc.?) Yes No Have you tried other treatment options (drugs, exercise, surgery, etc.) without full recovery? Question Title Have you tried other treatment options (drugs, exercise, surgery, etc.) without full recovery? Yes No Would you like some help with your current situation? Question Title Would you like some help with your current situation? Yes No Next
