Pelvic Therapy Specialists, PC
Specialized Treatment of Pelvic
and Lower Back Diagnoses
Health Questionnaire


  1. Do you have difficulty completely emptying when you urinate or feel your urine stream is slow?

  2. Do you have difficulty beginning urination?

  3. Do you know where all the restrooms are located in your favorite shopping locations?

  4. Does your pain radiate to your lower abdomen, pelvic region or lower back?

  5. Do you have difficulty defecating?

  6. Do you leak urine when you cough, sneeze, lift or change positions?

  7. Do you have tailbone or pelvic pain while sitting?

  8. Are you constipated regularly?

  9. Have your pelvic examinations become more painful?

  10. Do you have pain with urination?

  11. Do you leak fecal matter throughout the day?

  12. Do you have pain during or after intercourse?

  13. Do you leak urine during or after intercourse?

  14. Do you strain to have a bowel movement?

  15. Do certain foods or drinks make your pain worse?

  16. Is your sciatic pain getting worse with the duration of your pregnancy?

  17. Have you been told you may have a tummy separation during or after pregnancy?

  18. Are you leaking urine after your prostate surgery?

  19. Is it painful or irritating to wear underwear or pants?

  20. Do you experience numbness in your genital region?

  21. Are you experiencing low back pain related to pregnancy?

  22. Do you experience pelvic pain and difficulty with erections?


If you answered "yes" to any of these questions, you may be appropriate for physical therapy.

Call us today or consult with your doctor about your symptoms or condition. 


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Serving: All of the Denver metro area including: Boulder, Louisville, Superior, Lafayette, Longmont, Arvada, Westminster, Thornton, Brighton, Erie, Frederick, Firestone, North Denver, Northglenn, Broomfield, Colorado, Golden, Wheat Ridge, Lyons, Lakewood, Dacono, Commerce City.