Centre For Restorative Medicine

  • Symptomology Questionnaire

    Please answer the following questions to help assess your pelvic floor and intimate wellness symptoms.

  • Pelvic Floor / Incontinence Symptoms

    Please answer Yes or No to each of the following:
  • Do you leak urine when coughing, laughing, sneezing, or jumping?*
  • Do you have trouble getting to the restroom before leaking?*
  • Do you wear feminine protection pads regularly?*
  • Do you urinate frequently (more than 8 times per day)?*
  • Do you wake up multiple times at night to urinate?*
  • Do you experience a sudden, urgent need to urinate?*
  • Do you have difficulty emptying your bladder completely and experience dripping when you stand up?*
  • Do you feel you have weak pelvic floor muscles?*
  • Do you experience pelvic pressure or heaviness?*

  • Intimate Wellness Symptoms

    Please answer Yes or No to each of the following:
  • Do you experience vaginal dryness?*
  • Do you experience vaginal itching or irritation?*
  • Do you experience vaginal laxity or looseness?*
  • Do you have reduced vaginal sensation?*
  • Do you experience pain during intercourse?*
  • Do you experience discomfort during intimacy?*
  • Do you have decreased sexual satisfaction?*
  • Do you have decreased libido or sex drive?*
  • Do you experience sexual dysfunction?*
  • Do you have difficulty achieving orgasm?*
  • Do you have reduced confidence in intimate situations?*
  • Should be Empty: