Pelvic Floor and Incontinence Questionnaire
We are looking for pregnant women and moms up to 6 years postpartum to test HappySneeze.
As a tester, the Program is offered at NO COST to you, and you will have the support of a Registered Nurse throughout the Program.
If your profile qualifies to participate in an upcoming test we will get in contact with you soon.
Your responses are confidential and used for research purposes only.  We will not share or sell your information.
Learn more about our Privacy  Policy here https://www.happysneeze.com/general-8-1
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What is your email
Confirm your email
What is your first name?
What is your last name?
What is your date of birth?
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What best defines you?
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What was the date of your last birth, or your due date if you are currently pregnant?
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Is this your first child?
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What type of birth was it?
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Was this a multiple birth? (eg. twins or triplets)
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Did you have a perineal tear during this birth?
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How often do you leak urine?
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We would like to know how much urine you think leaks. How much urine do you usually leak (whether you wear protection or not)
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Overall, how much leaking urine interferes with your daily life?
Not at all
A great deal
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When does urine leak? Please check all that apply to you
Did you leak urine before you were pregnant?
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Have you had previous gynecological or abdominal surgeries?
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If you have had previous gynecological or abdominal surgeries, please describe what kind
Are you undergoing any kind of treatment or routine for pelvic floor recovery or incontinence?
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If you are undergoing a  treatment or routine for pelvic floor recovery or incontinence, describe what it consists of.
What is your weight?
What is your height?
What is your Country of residence
If in the United States, what state do you reside in?
Are you a healthcare professional?
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What is your fluency in the English language?
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Who told you about HappySneeze?
Do you want to receive updates from HappySneeze, including the opportunity to participate in upcoming tests? We promise not to spam you
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