Benign Prostatic Hyperplasia Quiz

Take This 30 Second Survey to See If You Have BPH

Welcome to your Benign Prostatic Hyperplasia (BPH) Quiz

Have you ever had any bladder "accidents"?

Yes

How many times, in the past month, did you get up to urinate between the time you went to bed for the night and the time you woke up for the day?

Not at all

Once

Twice

Three Times

Four+ Times

Your Name

Your Phone Number

ASUI Office Location

Preferred Appointment Date

Preferred Appointment Time

Your Email

Select Your Sex

Male Female

Comment or Message

I Would Like to Speak With a Provider About My...

Are You a New or Returning Patient?

New Returning