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1. Do you pee more than 8 times during daytime 1. Do you pee more than 8 times during daytime Yes No

2. Do you pee more than once after going to sleep 2. Do you pee more than once after going to sleep Yes No

3. Do you rush to go the toilet 3. Do you rush to go the toilet Yes No

4. Do you leak on your way to the toilet 4. Do you leak on your way to the toilet Yes No

5. Do you need to push to pee 5. Do you need to push to pee Yes No

6. Do you leak when you cough, sneeze or exercise 6. Do you leak when you cough, sneeze or exercise Yes No

7. Do you feel the urge to pee, but you pee only a little 7. Do you feel the urge to pee, but you pee only a little Yes No

8. Do you pee frequently without having to 8. Do you pee frequently without having to Yes No

9. Do you have a slow urine stream 9. Do you have a slow urine stream Yes No

10. Do you take time before the pee comes out 10. Do you take time before the pee comes out Yes No