Running Questionnaire Study - Screening Survey

Please complete the following survey so that we can determine if you are eligible for this study. You information will be kept confidential.

Question Title

1. Please enter your contact information here (Required.)

Full Name

Email Address

Question Title

2. Please enter your age (Required.)

Question Title

3. Are you... (Required.)

Male

Female

Prefer Not to Say

Other (please specify)

Please think about the last four weeks when answering the following questions.

Question Title

4. Have you ever leaked urine during your daily activities (Required.)

Yes

Question Title

5. Have you ever leaked urine while laughing, coughing, or sneezing? (Required.)

Yes

Question Title

6. Have you ever leaked urine during physical activity or exercise? (Required.)

Yes

Question Title

7. Have you ever leaked urine during running, jogging or brisk walking? (Required.)

Yes

Question Title

8. Do you regularly do physical activities, exercise or sports? (Required.)

Yes

Question Title

9. Do you run, jog or briskly walk as a form of physical activity or exercise? (Required.)

Yes

Question Title

10. Have you ever been pregnant beyond the second trimester? (Required.)

Yes

Question Title

11. How many children have you given birth to? (Required.)

Question Title

12. Are you currently pregnant? (Required.)

Yes

Question Title

13. Have you given birth in the last 12 months? (Required.)

Yes

Running Questionnaire Study - Screening Survey

Question Title

* 1. Please enter your contact information here (Required.)

Question Title

* 2. Please enter your age (Required.)

Question Title

* 3. Are you... (Required.)

Question Title

* 4. Have you ever leaked urine during your daily activities (Required.)

Question Title

* 5. Have you ever leaked urine while laughing, coughing, or sneezing? (Required.)

Question Title

* 6. Have you ever leaked urine during physical activity or exercise? (Required.)

Question Title

* 7. Have you ever leaked urine during running, jogging or brisk walking? (Required.)

Question Title

* 8. Do you regularly do physical activities, exercise or sports? (Required.)

Question Title

* 9. Do you run, jog or briskly walk as a form of physical activity or exercise? (Required.)

Question Title

* 10. Have you ever been pregnant beyond the second trimester? (Required.)

Question Title

* 11. How many children have you given birth to? (Required.)

Question Title

* 12. Are you currently pregnant? (Required.)

Question Title

* 13. Have you given birth in the last 12 months? (Required.)

1. Please enter your contact information here (Required.)

2. Please enter your age (Required.)

3. Are you... (Required.)

4. Have you ever leaked urine during your daily activities (Required.)

5. Have you ever leaked urine while laughing, coughing, or sneezing? (Required.)

6. Have you ever leaked urine during physical activity or exercise? (Required.)

7. Have you ever leaked urine during running, jogging or brisk walking? (Required.)

8. Do you regularly do physical activities, exercise or sports? (Required.)

9. Do you run, jog or briskly walk as a form of physical activity or exercise? (Required.)

10. Have you ever been pregnant beyond the second trimester? (Required.)

11. How many children have you given birth to? (Required.)

12. Are you currently pregnant? (Required.)

13. Have you given birth in the last 12 months? (Required.)