Elmiron & Eye Health

1. Basic Information

Question Title

* 1. What sex are you?

Male

Female

Other (please specify)

Question Title

* 2. How old are you today?

Under 20

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 or over

Question Title

* 3. How old were you when were first diagnosed with IC?

Under 20

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 or over