Personalized Pelvic Floor Exercises Step 1 of 4 25% Name(Required) First Last Email(Required) Phone(Required) Patient InfoGender(Required)FemaleMaleOtherAge(Required)Height (Inches)(Required) Weight (lbs)(Required) Pelvic Health Check - Do you ...1. Usually experience pressure in the lower abdomen?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 2. Usually experience heaviness or dullness in the pelvic area?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 3. Usually have a bulge or something falling out that you can see or feel in your vaginal area?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 4. Ever have to push on the vagina or around the rectum to have or complete a bowel movement?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 5. Usually experience a feeling of incomplete bladder emptying?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 6. Ever have to push up on a bulge in the vaginal area with your fingers to start or complete urination?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 7. Feel you need to strain too hard to have a bowel movement?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 8. Feel you have not completely emptied your bowels at the end of a bowel movement?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 9. Usually lose stool beyond your control if your stool is well formed?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 10. Usually lose stool beyond your control if your stool is loose?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 11. Usually lose gas from the rectum beyond your control?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 12. Usually have pain when you pass your stool?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 13. Experience a strong sense of urgency and have to rush to the bathroom to have a bowel movement?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 14. Does part of your bowel ever pass through the rectum and bulge outside during or after a bowel movement?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 15. Usually experience frequent urination?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 16. Usually experience urine leakage associated with a feeling of urgency, that is, a strong sensation of needing to go to the bathroom?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 17. Usually experience urine leakage related to coughing, sneezing or laughing?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 18. Usually experience small amounts of urine leakage (that is, drops)?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 19. Usually experience difficulty emptying your bladder?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit 20. Usually experience pain or discomfort in the lower abdomen or genital region?(Required) Not Present (Never Experienced) Not At All (Previously Experienced) Somewhat Moderately Quite a Bit Please explain your experience in your own words.What are the goals you hope to achieve? Custom Pelvic Exercises Price: Credit CardCard Details Cardholder Name Δ
