This 3 minute questionnaire asks questions about your prostate, urination, energy levels and symptoms that you may be experiencing.

Answers are used to create a "symptom score" to help assess the situation.

Some of the questions ask you to reflect on the quality of life of yourself or the individual you are answering for. Honest assessment is the first step in taking positive personal action.

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* 1. Please confirm your gender and who the survey is about?

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* 2. Please enter the Participants Name

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* 3. Where would you like the results sent?

Assessment

Rate your experience of the following sensations, experiences or symptoms over the last month.

Tip - Trust your initial response; don’t take too long thinking about each answer.

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* 4. Feeling unsatisfied after urination that the bladder was not fully emptied.

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* 5. Having to urinate again less than two hours after the last time

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* 6. Noticed the flow of urine stopped and started several times while urinating

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* 7. Found it difficult to wait to urinate or felt like I needed to urinate urgently

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* 8. Saw the flow of urine was weak or had less pressure than normal

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* 9. Strained, struggled or had to push to begin urination

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* 10. I have to get up to urinate five to several times during the night

Reflection

Consider the following statements and ask yourself how much you agree or disagree with them. Again, trust your initial response; don’t take too long thinking about each answer

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* 11. The symptoms associated with my prostate do not bother me

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* 12. My libido has not been significantly negatively impacted by my age

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* 13. I am happy with my ability to perform sexually when I want to

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* 14. I have sufficient energy to get me through the day with relative ease

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* 15. I am happy with my overall wellbeing and health status

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* 16. I support my body with a healthy lifestyle and quality nutrition

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* 17. I have no major health conditions impacting my life

Click "done" to get your results.
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