About the Condition
0%
Back
Are you experiencing incontinence issues right now?
Have you experiencing any side effects as a result of your treatment?
Have you been taking Vesicare 5mg Tablets for a long time?
Please select your option
Do you have any of the following problems:
A complete inability to pass pee or a great deal of trouble passing urine.
Does any of the following statements apply to you:
Orlistat causes an allergic reaction or hypersensitivity in you.
What is your biological gender?
Please select your option
If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option
Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.
Can you relate to any of the following?
You have an underlying medical condition
Is your doctor now prescribing Vesicare 5mg Tablets to treat urinary incontinence?
Do you require assistance?
Are you aware of the following:
It is never a good idea to self-diagnose and treat urine incontinence.
Have undergone a diabetes examination or do you already have it?
If you do have diabetes, please provide us with as much information as you can regarding your diagnosis or test.
How often do you experience incontinence issues?
Please select your option
Have you seen a doctor about your incontinence condition?
If you have, what was is the main reason of your incontinence and your doctor's recommendation?
Do select the any of following symptoms that you may be experiencing:
You can choose one or more options
Do you have to urinate frequently in the middle of the night?
If you answered yes, please estimate how many times you need to get up to urinate during a regular night.
Do you experience any discomfort when passing urine?
Do you get cystitis (bladder infections) on a regular basis?
If you answered yes, please describe how frequently you have bladder infections and how severe they are.
Has a doctor examined your prostrates lately?
This question must only be answered by men. Women, please answer "yes"
Do you use water pills like diuretics, furosemide or bendroflumethiazide?
Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.
Submit
