Pelvic Floor Health Screening - Part 1 To be completed prior to 1st session Question Title * 1. Do you pee when you sneeze, laugh, jump or move to a new position? Never Sometimes All the time Describe these events Question Title * 2. Do you pee more than once every 2 to 3 hours? Never Sometimes All the time Question Title * 3. Do you feel any sudden urgency to pee at the oddest times? Never Sometimes All the time Please specify where and when this happens. ( eg. during recreational walks, when entering your home, at the supermarket etc) Question Title * 4. Do you usually feel relaxed and can take your time when you pee or need to pee? Never Sometimes All the time Question Title * 5. Do you pee more than once at night? Never Sometimes All the time Question Title * 6. Do you dribble after you get up from the toilet? Never Sometimes All the time Question Title * 7. Do you bear down to eliminate or to pee? Never Sometimes All the time Question Title * 8. Do you experience constipation? (you are not constipated if you eliminate daily and the feces are the consistency of a banana Never Sometimes All the time Question Title * 9. Do you have fecal incontinence? Never Sometimes All the time Question Title * 10. Please enter your name, age and any other information that you feel would help to expand on the previous questions. Once you complete this questionnaire, please take a moment to complete the Pelvic Floor Health Screening Part 2. (All information is confidential and will not be shared with anyone else than Jackie Leduc) click here to submit responses. Please complete part 2