Get Pelvic Floor Impact Questionnaire

The Pelvic Floor Impact Questionnaire is a valuable tool designed to assess how bladder, bowel, and vaginal symptoms impact a person's daily activities and emotional wellbeing. This guide provides clear instructions for completing the questionnaire online, ensuring that you can provide accurate information about your experiences.

Follow the steps to successfully complete your questionnaire.

1. Press the ‘Get Form’ button to access the Pelvic Floor Impact Questionnaire and open it in your preferred editor.
2. Begin by entering your name in the designated space at the top of the questionnaire to identify your responses.
3. For each question regarding how your symptoms have affected your daily activities over the past three months, mark an 'X' in the response that best depicts your situation. The options include: 'Not at all', 'Somewhat', 'Moderately', and 'Quite a bit'.
4. Move through each question, which addresses various areas such as household chores, physical activities, entertainment, travel, social participation, emotional health, and feelings of frustration.
5. After completing all sections, calculate your score based on the given scoring system: 0 for 'Not at all', 1 for 'Somewhat', 2 for 'Moderately', and 3 for 'Quite a bit'. Record your final score if needed.
6. Provide your signature and date at the bottom of the form, and if applicable, allow your therapist to sign and date the document as well.
7. Finally, save any changes you made to the questionnaire, and consider downloading, printing, or sharing the completed form as required.

Complete your Pelvic Floor Impact Questionnaire online today for a better understanding of your symptoms.