We want to learn a little more about you to see how we can help.

This 5 minute questionnaire asks questions about your prostate, urination, energy levels and symptoms that you may be experiencing.

We use your answers to help create a 'Symptom Score', so we can assess how best we can help.

The questions will ask you to think about your current lifestyle or the lifestyle of someone you care about. The more honest you are the better you can help yourself.

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* 1. Who are you

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* 2. Please enter your First Name or the First Name of the person you care about

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* 3. What's your age

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* 4. What's your best email to send your results to

Assessment

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

Remember to give your honest response.

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

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* 5. How do you feel after you urinate, do you feel like you were able to empty your bladder

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* 6. When do you feel like you have to urinate again

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* 7. Do you have trouble when you urinate, do you stop and start

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* 8. Have you ever experienced having to wait or felt like you needed to urinate urgently

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* 9. When you urinate have you experienced a weak stream or less pressure than normal

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* 10. Have you strained, struggled or had to push to begin urinating

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* 11. I have to get up 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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* 12. The symptoms associated with my prostate do not bother me

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* 13. My libido has not been significantly (negatively) impacted by my age

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

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

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* 16. I am happy with my overall health and wellbeing currently

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* 17. I maintain a healthy lifestyle with quality nutrition

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

Click "done" to get your results.
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