Find Real Relief with Axonics® Therapy or Bulkamid®

Take the first step toward real relief:

Take this short quiz to get started and see whether Axonics Therapy or Bulkamid may be right for you.

Do you experience any of the following bowel and/or bladder control symptoms?
(Choose all that apply) Frequent urination Sudden or strong urge to urinate Urine leakage with little or no warning Urine leakage with exertion (eg, laughing, sneezing, exercise) Incomplete emptying of the bladder Bowel Leakage None of the above

How long have you had bladder control symptoms? Less than 6 months 6 to 12 months Between 1 and 5 years More than 5 years

How much do your bladder control symptoms affect your quality of life? Very severely Severely Moderately Slightly No effect

Has a doctor ever diagnosed you with any of the following?
(Choose all that apply) Overactive bladder (OAB) Urge urinary incontinence (UUI) Stress urinary incontinence (SUI) Urinary retention (UR) Fecal incontinence (FI) None of the above

Do you currently have a doctor managing your bladder control issues?
(If you have several, choose the one you consult most often.) Primary care doctor OB/GYN Urologist Urogynecologist Another doctor I don't have a doctor at this time

Have you ever tried any of the following treatments?
(Choose all that apply) Lifestyle changes (eg, dietary changes, limiting or timing fluid intake) Pelvic floor exercises or pelvic physical therapy Sacral neuromodulation (SNM, eg, Axonics or InterStim) Pelvic sling or other surgical procedure BOTOX injections None of the above

How old are you? 17 or younger 18 to 34 35 to 49 50 to 64 65 to 79 80 or older

What is your sex, as assigned at birth? Male Female I prefer not to say

What type of insurance do you have? Private insurance (either employer-provided or self-purchased) Medicare or Medicare Advantage Medicaid or government-assisted program TriCare/Veterans Affairs No insurance/self-pay

Are you currently taking prescription bladder control medication(s)? Yes No, but I have tried them in the past No, I’ve never taken them

How many prescription bladder control medications have you tried? One Two Three or more None of the above

Why did you stop taking your bladder control medication?
(Choose all that apply) Never worked Did not work well enough Stopped working Side effects Cost/insurance issues Other None of the above

How did you hear about us?
(Choose all that apply) TV ad Internet - Facebook/Instagram Internet - Web Search/Browsing Doctor recommendation Family member/friend YouTube Other

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