Live Happy and Well

“Your Path to Prostate Health and Comfort”

We would like to use the following BPH symptoms score index to evaluate your enlarged prostate (Click the most accurate answer below)

Questionnaire

1. How old are you?

35 - 44 Years

45 - 54 Years

55 and Above

2. How often do you get up to urinate from the time you went to bed at night until the next morning?

Slightly Often

Really Often

Not at All

3. How often do you have a feeling of not emptying your bladder completely after you finished urinating?

Very often

Slightly often

Not at All

4. How often do you find it difficult to postpone your urine?

Very often

Slightly often

Not at All

5. Do you want a complete natural solution that will reduce frequent urination to normal?

YES

NO

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