Completely Confidential

Your responses will never be shared with anyone.

Your score begins at 100 and, based on your answers, the score lowers as an indicator of severity and/or risk of core floor dysfunction. Certain answers are weighted higher than others with regards to how they affect your score.

Some of these questions/answers are personal and life influencing. To create the most accurate baseline of your core floor health, please answer each question thoughtfully and accurately.

1. Have you been pregnant and/or delivered a child in the last 12 months?
2. Do you sit for more than 50% of your day?
3. Do you exercise 3 or more days/week?
4. Do you ever leak urine with coughing, laughing, sneezing, squatting or with exercise?
5. Do you ever leak urine trying to get to the bathroom?
6. Do you ever feel you may “leak” stool or have difficulty making it to the bathroom for a bowel movement?
7. Do you have pain with intercourse or avoid intercourse for fear of pain?
8. Is your quality of life impacted by urinary or pelvic pain issues?
9. Do you have a strong sense of urgency when you have to urinate?
10. Do you go to the bathroom more often than every 3 hours?
11. Do you have pain with using a tampon, or with GYN exams?
12. Do you get up more than 1x per night to go to the bathroom?
13. Do you have difficulty holding back gas?
14. Do you have general pelvic type pain (including vaginal pain, abdominal pain, hip/groin pain) during the day related to specific activities you do or clothes you wear?
15. Have you ever been diagnosed with a vaginal prolapse, experienced vaginal pressure or have had a feeling the something is "falling out" of your vagina?
16. Are you in or have you gone through any of the following: peri-menopause, menopause, or post-menopause?