Developed and funded by Ferring Pharmaceuticals as a service to medicine

Nocturia Quality of Life questionnaire

Nocturia
Quality of Life
questionnaire

To see how Nocturia is affecting you COMPLETE, PRINT and TAKE WITH YOU when you visit your healthcare professional.

Complete the Nocturia Quality of Life questionnaire by either filling in your answers online and clicking save to your device, or downloading, printing and completing it by hand. Bring your completed questionnaire to your appointment with your healthcare professional.

Nocturia Quality of Life questionnaire

  • 1. Please enter your date of birth:
  • DAY MONTH YEAR
  • OVER THE PAST FOUR WEEKS, HAVING TO GET UP AT NIGHT TO URINATE…
    (click one)
  • OVER THE PAST FOUR WEEKS, I HAVE BEEN…
    (click one)
  • Please click a number between 0 (not at all) and 10 (a great deal)

INFORMATION FOR HEALTHCARE PROFESSIONALS ONLY

0-52 overall score with greater values indicating increased impact on quality of life.

Bother scale not incorporated into overall score, but indicates impact of symptoms
overall for the patient.

GO BACK

Reclaim your night.
Re-energise your day.

Nocturia is usually easy to treat, so if your night-time bathroom trips are affecting your day to day life, it’s time to talk to your healthcare professional. Together, you and they may be able to determine the cause of your Nocturia and decide on the best treatment option so that you can reclaim your nights and re-energise your days.

TALK TO YOUR DOCTOR TO
DISCUSS YOUR SYMPTOMS
AND TREATMENT OPTIONS

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