Health Questionnaire

• Do you have difficulty completely emptying when you urinate?
  
• Does you have pain radiating to your lower abdomen, pelvic region or low back?
• Do you have difficulty defecating?
• Do you leak urine when you cough, sneeze or lift?
• Do you have tailbone or pelvic pain while sitting?
• Are you constipated regularly?
• Have your pelvic examinations become more painful?
• Do you have pain with urination?
• Do you leak fecal matter or gas throughout the day?
• Do you have pain during or after intercourse?
• Do you have painful periods?
  
• Do you strain to have a bowel movement?
• Do certain foods or drinks make your pain worse?
• Is your sciatic pain getting worse with the duration of your pregnancy?
• Have you not felt as stable or strong since your pregnancy?
  

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If you answered yes to any of these questions, you may be appropriate for physical therapy.  Consult with your healthcare provider about getting a prescription for physical therapy for a thorough evaluation and treatment plan. If you have any questions, please feel free to contact our office.