Axonics

During the last three months, have you leaked urine (even a small amount)?

Yes
No

Which of the following have you experienced in the last 3 months? (Check all that apply)

I leaked urine while performing physical activities (lifting, exercise), coughing/sneezing, or laughing.
I experienced an urgent need to empty my bladder, but I couldn’t get to the toilet fast enough.
I leaked urine without physical activity and without a sense of urgency.

When do you leak urine most often? (Check only one)

While performing physical activities (lifting, exercise), coughing/sneezing, or laughing.
When experiencing an urgent need to empty my bladder, but I couldn’t get to the toilet fast enough.
Without physical activity and without a sense of urgency.
About equally as often with physical activity as with a sense of urgency.

During the last three months, have you leaked stool (even a small amount)?

Yes
No

Would you be interested in learning about a long-lasting therapy option that may help you with your symptoms?

Yes
No

If you have answered "yes" or selected any additional answers to any of the above questions, please request an appointment with a member of our Women’s Health team

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Take the following survey to see if you should make an appointment.

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