Get Incontinence Questionnaire - Lansing Institute Of Urology

The Incontinence Questionnaire is an essential tool for assessing urinary incontinence and tailoring treatment options. Completing this questionnaire online can help ensure you provide accurate information to your healthcare provider, enhancing your care experience.

Follow the steps to successfully complete the Incontinence Questionnaire

1. Click ‘Get Form’ button to obtain the questionnaire and open it in your preferred format.
2. Begin by entering your name in the designated field at the top of the form. It is important to provide your full name for accurate patient records.
3. Answer the first series of questions about urinary leakage related to specific activities (e.g., coughing, sneezing). Select the appropriate frequency from the given options, marking 'Always' or 'Never' as it applies to you.
4. Indicate how wet your clothing gets due to the leaks by selecting from the corresponding options: 'Damp', 'Wet', or 'Soaking Wet'.
5. Specify what type of protection you utilize for incontinence. Check the appropriate options such as 'Pads', 'Tissue', or 'Diapers', and enter the number of protective pads used daily.
6. Respond to the questions about specific types of leakage patterns and how they affect your daily life. These questions will help your healthcare provider understand your condition better.
7. Provide additional information about your urinary habits, such as frequency during the day and at night, and describe the volumes of urine typically passed.
8. Complete the section requesting a summary of fluid intake over a 24-48 hour period, listing the specific times, types of beverages consumed, and the volumes.
9. After filling out all sections, review your answers for accuracy. Make any necessary corrections before finalizing the form.
10. Once complete, choose to save your changes, download the document for your records, print the form, or share it with your healthcare provider as needed.

Start your journey toward better health by completing the Incontinence Questionnaire online today.