ICIQ-UI Short Form

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Many people leak urine some of the time. We are trying to find out how many people leak urine, and how much this bothers them. We would be grateful if you could answer the following questions, thinking about how you have been, on average, over the PAST FOUR WEEKS.
Date / Time
Please write in your date of birth:
Are you
How often do you leak urine?
We would like to know how much urine you think leaks. How much urine do you usually leak (whether you wear protection or not)?
Selected Value: 0
Please ring a number between 0 (not at all) and 10 (a great deal)
When does urine leak?
(Please tick all that apply to you)