Take the Self-Assessment Urinary Control test  |
This brief test will help you to monitor your results before and after using BetterWOMAN.
- Print out the form.
- Mark your current scores before taking BetterWOMAN.
- After you finish your 3rd bottle of BetterWOMAN, take the test again.
- Compare your before-after scores to see how BetterWOMAN has improved your health.
Female Urinary Control and Energy Level Inventory |
Score Definition |
Before Taking BetterWOMAN
Date: _______ |
After 3rd
Bottle of BetterWOMAN Date: _______ |
1. During the past 30 days, how often did you feel "leaking" when you coughing, laughing, sneezing, bending, or exercising? |
0 = Never
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Always |
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2. During the past 30 days, how often did you feel the abrupt urgency to urinate? |
0 = Never
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Always |
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3. During the past 30 days, how often did you feel you had to go all the time? |
0 = Never
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Always |
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4. During the past 30 days, how often did you feel you were exhausted? |
0 = Never
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Always |
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5. During the past 30 days, how often did you feel you were tired? |
0 = Never
1 = Rarely
2 = Occasionally
3 = Frequently
4 = Always |
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In what area(s) did BetterWOMAN help you?
• Improving urinary control ______Yes _____No _____Not sure
• Improving energy levels _____Yes _____No _____Not sure
Name: __________________________ Age: _____ Phone#:_____________
Comments or Suggestions |
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