P-CHECK WELLNESS

1. Are you experiencing a burning sensation when urinating?

Yes, frequently Sometimes No

2. Do you feel the urge to urinate often, even when little comes out?

Yes Occasionally 30

3. Have you noticed any of the following?

Cloudy Urine Strong or unusual odor Pelvic pressure or lower abdominal discomfort None of the above

4. Have you had a UTI before?

Yes, multiple times Yes, once or twice No

5. Are you currently taking antibiotics for a UTI?

Yes No

6. Have you recently experienced?

Vaginal Dryness Intimate Odor Imbalance Yeast Infection None of the above

7. Have your symptoms started within the last 7 days?

Yes No I'm not sure

8. Do your symptoms tend to appear after intimacy?

Yes, often Occasionally No

9. How often do you experience urinary discomfort in a year?

3+ times a year 1-2 times per year Rarely or never

10. Are you currently looking for natural support options?

Yes, I prefer natural solutions I'm open to both natural & subscriptions No, I prefer subscription only