Sullivan Physical Therapy
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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?

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.
Sullivan Physical Therapy, Women's Health, Coccygodynia, Constipation, Diastasis Recti, Dysmenorrhea, Dyspareunia, Endometriosis, Fecal Incontinence, Incomplete Bladder Emptying, Interstitial Cystitis, Irritable Bowel Syndrome, Levator Ani Syndrome, Overactive Bladder Syndrome, Pelvic/Genital Pain, Prolapse Prostatitis, Pudendal Neuralgia, Sciatica, Urinary Incontinence, Vaginismus, Vestibulodynia, Vulvodynia, Austin
Sullivan Physical Therapy
12411 Hymeadow Drive
Building 3, Suite 3B
Austin, Texas 78750
Phone: 512-335-9300
Fax: 512-335-9301
​ sullivanphysicaltherapy@yahoo.com
© 2022 Sullivan Physical Therapy
All Rights Reserved

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