Pure Barre Bladder Study BASELINE Questionnaire

Pure Barre Bladder Study Screening Questions

Find out if you are eligible!

-Must be a NEW client OR no Pure Barre in the past 3 months with Urinary Incontinence
-Complete a baseline questionnaire
-Complete 10 Pure Barre classes within 2 months or sooner & a follow-up questionnaire

-Receive $50.00 debit card by mail!

Contact: rbriski2@hfhs.org OR 313-932-5733 with any questions

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* 1. Do you experience ANY urinary incontinence (leakage of urine) at least 1 time per week?

Yes

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* 2. Are you over age 18?

Yes

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* 3. Which sex were you at birth?

Female

Male

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* 4. Are you currently receiving pelvic floor physical therapy?

Yes

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* 5. Do you plan to have pelvic surgery in the next 2 months during study participation?

Yes

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* 6. Are you currently pregnant?

Yes

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* 7. Did you deliver a child less than 6 weeks ago?

Yes

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* 8. Have you been diagnosed with chronic pelvic pain OR chronic bladder pain

Yes

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* 9. Have you taken a Pure Barre class in the past 3 months?

Yes

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* 10. Will you be able to complete 10 Pure Barre classes in 2 months or less?

Yes