Full Name
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Phone
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Email
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Address
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City, State, Zip
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Is it more difficult to urinate than it used to be?
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Do you often dribble after the initial urine stream subsides?
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Do you have to push to start the flow of urine?
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Do you suffer from impotence or diminished libido?
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It is sometimes painful to urinate?
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Is your urinary stream weaker and less forceful than before?
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It is getting harder to wait when you have to urinate?
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Does your bladder not feel empty after urination?
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Does your urine stream stop and start several times?
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Do you get up to urinate more than once a night?
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