Overweight
BMI reading
Ideal weight chart
Ideal Body fat chart/Visual chart
Injury to pelvic area?
Type Injury:
Recurrent urinary condition and/or infection?
Type Urinary condition and/or infection and how often one has the condition
Bladder condition?
Weak pelvic floor muscles?
Overactive bladder?
Prostate Enlargement (male)
Prostate surgery such as radical prostatectomy or transurethral resection of the prostate (TURP, “roto-rooter” for enlarged prostate) (male only)
Prostate surgery (male only)
Bladder catheterization
Cystoscopy
Radiation treatment or radioactive seeds (for prostate cancer) (male only)
Other bladder treatment and/or condition