Developed and funded by Ferring Pharmaceuticals as a service to medicine

Nocturia Questionnaries

Adult-career-clipboard

Nocturia
questionnaire

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

Complete the Nocturia 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 questionnair 1

  • 1. Please enter your date of birth:
  • DAY MONTH YEAR
  • Please click on a number between 0 (not at all) and 10 (a great deal)
  • Please click on a number between 0 (not at all) and 10 (a great deal)

INFORMATION FOR HEALTHCARE PROFESSIONALS ONLY

0-8 overall score with greater values indicating increased symptom severity.

Bother scales are not incorporated in the overall score, but indicate impact of individual symptoms for the patient.

*Calculated by adding the scores of questions 3a and 4a

Reclaim your night.
Re-energise your day.

ICIQ Logo

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 Doctor

TALK TO YOUR DOCTOR TO
DISCUSS YOUR SYMPTOMS
AND TREATMENT OPTIONS

Feedback