ONLINE PROSTATE MEDICAL TEST FORM FOR STATUS DIAGNOSIS

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FILL THE FORM BELOW TO GET YOUR DIAGNOSIS TEST RESULT

Do You Know Prostate Enlargement Is A Natural Occurance In Every Man?

No I Am Not Aware
Yes I Am Aware

Some Men Get To Experience The Signs & Symptoms As Early Age Of 25-35 Years While Some As Late As 45-70 years!?

What Is Your Age Range?

25 - 35
36 - 50
51 - 60
61 - 85

Do You Experience Frequent Urination(Waking Up 1 To 4 time At Night To Pee)

If YES: When Did You Started Experiencing Frequent Urination

No Frequent Urination At Night
Yes Less Than A Year
Yes Over 1 Year Plus
Yes Over 2 to 3 Years Now
Yes within 4 To 7 Years
Yes 10 Years Plus

DO YOU EXPERIENCE PREMATURE EJACULATION?

YES
NO
SOMETIMES

Premature Ejaculation Implies when Ejaculation occurs faster than you and your partner would like

Do You Experience Low sex Drive/ Loss For Sexual Activity With Your Partner?

Yes
No
Sometimes

Do you find yourself gradually lossing interest in sex, foreplay or anything about sex intimacy,

Do You Feel Any Pain Or Burns While Urinating?

YES
NO
SOMETIMES

Do You Experience Tiredness Or Loss Of Energy Unexpectedly?

YES
NO
SOMETIMES

Do You Experience Lower Back Pain?

Yes.
No.
Sometimes

Do You Experience Any Form Of Decreased Flow Or Velocity Of Stream While Urinating?

YES
NO
SOMETIMES

When Urinating Do Experience Long Stream, Stoppage, Short Stream Or Loss Of Bladder Control.

Do You Encounter Difficulties Starting Or Stopping While Urinating?

YES
NO
SOMETIMES

Do You Experience Any Prompt Urgency To Urinate?

YES
NO
SOMETIMES

Do suddenly without any warning the sudden urge to urinate immediately without warning.

Do You Use Force To Urinate, Straining or pushing Yourself while urinating?

YES
NO
SOMETIMES

Have You Administered Any Form Of Medication For Prostate Enlargement(BPH)? *

No, I Have Not.
Yes, I Have.
I Am Not Sure.

Are You Aware When The Early Stage signs & Symptoms Of Prostate Enlargement is Left Unattended To, 90% of Early Signs Result To Severe Medical Emergencies ?

Yes, I Am Aware
No, I Am Not Aware

Severe Medical Emergencies Such as *Inability To Urinate *Inability To Maintain An Erection *Blood In Urine, *Uncontrolable Urination, *Severe Back Pain, *Frequent Loss Of Energy etc?

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