Bladder Study - Doctor

Doctor Participation: Bladder Study

Thank you for participating in this questionnaire. Your responses will help us understand your patient population better.
Name*

First NameLast Name
Office Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Your Specialty*

General PracticeUrologyNeurologyGeriatrics
Other:
Please share the approximate number of patients you see with bladder disorders between the ages of 18-39:*

1-5051-100100+None
Other:
Please share the approximate number of patients you see with bladder disorders between the ages of 40-55:*

1-5051-100100+None
Other:
Please share the approximate number of patients you see with bladder disorders between the ages of 55+:*

1-5051-100100+None
Other:
Out of the total patients you indicated earlier, what percentage can undergo a cystoscopy?*
Indicate what percentage of your patients are willing to self-catheterize:*
Comments:
CV (optional)

Cancelof
Thank you for your valuable input in this bladder study questionnaire. Your insights are essential as we consider you for participation as a primary investigator in our study.
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Doctor Participation: Bladder Study