1. Incomplete emptying: How often have you had a sensation of not emptying your bladder completely after you finished urinating?
Select an answer 0 — Not at all 1 — Less than 1 time in 5 2 — Less than half the time 3 — About half the time 4 — More than half the time 5 — Almost always
2. Frequency: How often have you had to urinate again less than two hours after you finished urinating?
Select an answer 0 — Not at all 1 — Less than 1 time in 5 2 — Less than half the time 3 — About half the time 4 — More than half the time 5 — Almost always
3. Intermittency: How often have you found you stopped and started again several times when you urinated?
Select an answer 0 — Not at all 1 — Less than 1 time in 5 2 — Less than half the time 3 — About half the time 4 — More than half the time 5 — Almost always
4. Urgency: How often have you found it difficult to postpone urination?
Select an answer 0 — Not at all 1 — Less than 1 time in 5 2 — Less than half the time 3 — About half the time 4 — More than half the time 5 — Almost always
5. Weak stream: How often have you had a weak urinary stream?
Select an answer 0 — Not at all 1 — Less than 1 time in 5 2 — Less than half the time 3 — About half the time 4 — More than half the time 5 — Almost always
6. Straining: How often have you had to push or strain to begin urination?
Select an answer 0 — Not at all 1 — Less than 1 time in 5 2 — Less than half the time 3 — About half the time 4 — More than half the time 5 — Almost always
7. Nocturia: How many times did you typically get up to urinate from bedtime until morning?
Select an answer 0 — None 1 — 1 time 2 — 2 times 3 — 3 times 4 — 4 times 5 — 5 or more times