We would appreciate your assistance in completing the following set of questionnaires that ask about how you are managing your medical problems, including pain.

This set of questionnaires is special to us – offering us an in-depth look at how our patients are doing when they first come to the Women’s Urology and Pelvic Health Center Patient Forms. We recognize that most people are affected in many ways by medical problems, including pelvic pain.

The information you provide is kept confidential and may be used anonymously (or de-identified) for our research on women's health issues.

We realize that completing these questions will take some time on your part and we can’t thank you enough for your assistance. Your assistance will contribute to the science of understanding how health care can better meet the needs of other women like you.

Before Your Appointment

Forms that need to be completed for the initial appointment in the Women’s Urology Center include: 

If pain (pelvic, bladder or genital) is a problem for you, please complete the following questionnaires as well:

  • Brief Pain Inventory
  • Pain & Feelings

Download and print each form listed above. Please use an ink pen and fill out the forms completely. Mail completed forms to the address listed below. Please keep a completed copy and bring to your appointment in the event we don’t receive the forms that were sent in the mail.

Mailing Address

Women’s Urology and Pelvic Health Center Patient Forms, 2 South
Beaumont Hospital, Royal Oak
3601 W. 13 Mile Road
Royal Oak, Michigan  48073-6769