Are you "Peezing?"

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* 1. Do you (or someone you love) sometimes leak a little when you cough, sneeze or laugh?

Yes

No

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* 2. Do you (or someone you love) use protection "just in case?"

Yes

No

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* 3. Do you (or someone you love) dribble after peeing (Post Void Dribble aka PVD)?

Yes

No

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* 4. Do you (or someone you love) pee before leaving the house "Just in case?"

Yes

No

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* 5. Do you want to learn how to fix this for your self or for someone you love?

Yes

No

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* 6. If you said "Yes" to any of the above questions AND you want to fix this problem, then Charles can help! please leave your email or phone number and Charles will get back to you :-)

Name

Email Address