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URIGYN
MEGGA MIX
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Home
About Us
Science
URIGYN
MEGGA MIX
Video Gallery
Contact
First Name
Last Name
1. Age
*
Under 25
25-34
35-44
45-54
55-64
65+
Please choose your age
2. Country
*
3. Are you
*
Premenopausal
Perimenopausal
Postmenopausal
4. How many years have you experienced recurrent UTIs?
*
5. How many UTIs did you experience in the previous 12 months?
*
6. How many antibiotic courses did you take for UTIs in the previous 12 months?
*
Your rUTI Experience Before URIGYN
7. Before starting URIGYN, how much did rUTIs affect your DAILY LIFE
*
Not at all
Slightly
Moderately
Severely
Extremely
8. Before starting URIGYN, how much did rUTIs affect your SLEEP
*
Not at all
Slightly
Moderately
Severely
Extremely
9. Before starting URIGYN, how much did rUTIs affect your WORK
*
Not at all
Slightly
Moderately
Severely
Extremely
10. Before starting URIGYN, how much did rUTIs affect your RELATIONSHIPS
*
Not at all
Slightly
Moderately
Severely
Extremely
11. Before starting URIGYN, how much did rUTIs affect your SEXUAL ACTIVITY
*
Not at all
Slightly
Moderately
Severely
Extremely
12. Before starting URIGYN, how much did rUTIs affect your TRAVEL
*
Not at all
Slightly
Moderately
Severely
Extremely
13. Before starting URIGYN, how much did rUTIs affect your MENTAL HEALTH
*
Not at all
Slightly
Moderately
Severely
Extremely
14. Which symptoms bothered you most?
*
Burning with urination
Urgency
Frequency
Pelvic pain
Bladder pressure
Fear of recurrence
Fatigue
Other
Did you experience any other symptoms not mentioned above? If yes, please describe
Starting URIGYN
15. Why did you decide to try URIGYN?
Frequent infections
Antibiotic concerns
Antibiotic resistance
Recommendation by healthcare provider
Recommendation by another patient
Looking for prevention
Other
If you had any other reasons for trying URIGYN not listed above, please describe
16. How long have you been taking URIGYN?
*
Less than 1 month
1-3 months
3–6 months
6-12 months
More than 12 months
Changes Since Starting URIGYN
17. Since starting URIGYN, how has the number of UTIs changed?
*
Increased significantly
Increased slightly
No change
Reduced slightly
Reduced significantly
No UTIs since starting
18. Approximately how many UTIs have you experienced since starting URIGYN?
*
19. Since starting URIGYN, how has your antibiotic use changed?
Increased
No change
Reduced somewhat
Reduced substantially
Eliminated
Symptom Improvement
20. Compared with before URIGYN, rate any changes in URGENCY
*
Much Worse
Worse
No Change
Better
Much Better
21. Compared with before URIGYN, rate any changes in FREQUENCY
*
Much Worse
Worse
No Change
Better
Much Better
22. Compared with before URIGYN, rate any changes in BURNING
*
Much Worse
Worse
No Change
Better
Much Better
23. Compared with before URIGYN, rate any changes in PELVIC DISCOMFORT
*
Much Worse
Worse
No Change
Better
Much Better
24. Compared with before URIGYN, rate any changes in CONFIDENCE LEAVING HOME
*
Much Worse
Worse
No Change
Better
Much Better
25. Compared with before URIGYN, rate any changes in SLEEP
*
Much Worse
Worse
No Change
Better
Much Better
26. Compared with before URIGYN, rate any changes in MOOD
*
Much Worse
Worse
No Change
Better
Much Better
27. Compared with before URIGYN, rate any changes in SEXUAL CONFIDENCE
*
Much Worse
Worse
No Change
Better
Much Better
28. Compared with before URIGYN, rate any changes in OVERALL WELLBEING
*
Much Worse
Worse
No Change
Better
Much Better
Quality of Life
29. I feel more in control of my bladder health
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
30. I worry less about future infections
*
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
31. I am less dependent on antibiotics
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
32. I feel healthier overall
*
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
33. I would recommend URIGYN to someone with rUTIs
*
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
34. What is the biggest positive change you have noticed?
Whole-Body Health
35. Have you noticed changes in any of the following?
*
Digestion
Bloating
Energy
Fatigue
Joint discomfort
Sleep
Mood
Anxiety
Skin
None
Other
36. Please describe any changes not listed above
Safety and Tolerability
37. How easy is URIGYN to take?
*
Very difficult
Difficult
Neutral
Easy
Very easy
38. Have you experienced any side effects?
*
No
Yes
39. If YES, please describe
Your Story
40. What was life like before URIGYN?
41. What has changed since starting URIGYN?
42. What would you tell another woman suffering from recurrent UTIs?
43. May we share your story anonymously to help other women?
Yes
No
Option 3
44. May we contact you for a more detailed interview?
*
Yes
No
Option 3
45. If we may contact you for a more detailed interview, please provide your email address
Name
Submit
