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  • QUID: Questionnaire for female Urinary Incontinence Diagnosis

  • Today's Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year

  • Please answer the following 5 questions.  Do you leak urine (even small drops), wet yourself, or wet your pads or undergarments in the following situations:

  • 1. ..when you cough or sneeze?*
  • 2. ..when you bend down or lift something up?*
  • 3. ..when you walk quickly, jog, or exercise?*
  • 4. ..while you are undressing in order to use the toilet?*
  • 5. ..Do you ever get such a strong and uncomfortable need to urinate that you leak urine (even small drops), or wet yourself before reaching the toilet?*
  • 6. ..Do you ever have to rush to the bathroom because you get a sudden, strong need to urinate?*
  • Should be Empty: