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IC/PBS Questionnaire

(Interstitial Cystitis is sometime diagnosed as Painful Bladder Syndrome, Chronic Pelvic Pain, or Nonbacterial Prostatitis. We will use IC/PBS to represent all of those diseases.)

We are gathering data on our IC/PBS patient population that will be shared with researchers in order to better define how our freeze-dried Whole-Leaf Aloe Vera capsules are working in this disease. You can choose to remain anonymous if you like, but either way, your name will never be associated with the data during research. Hyperlink to our Privacy Policy for more information.

Thank you for taking a few minutes to answer the following questions.

Name (optional):
Email address (required):
Gender: Male Female

Month and year you were born:

Age when you first began experiencing symptoms of IC/PBS:

Age when you were diagnosed with IC/PBS:

Research has shown that IC patients are much more likely to have a constellation of diseases and problems than the general population. To determine the frequency of these associated problems, please mark those items that you continue to experience below:

Interstitial Cystitis (urinary frequency, urgency, and suprapubic pain)
Hunner's Ulcers in your bladder
Painful Bladder Syndrome
Chronic Pelvic Pain
Nonbacterial Prostatitis
Fibromyalgia
Vulvodynia
Irritable Bowel Syndrome (IBS)
Sjogren's Syndrome
Migraine Headaches
Pelvic Floor Dysfunction
Systemic Lupus Erythematosus
Chronic Fatigue Syndrome
Endometriosis
Allergies
Asthma
Sensitive Skin

Do any foods or beverages make your symptoms worse? Yes No

If yes, which foods and beverages make your symptoms worse?

Did Desert Harvest's Whole-Leaf Aloe Vera capsules make your feel better? Yes No

How long did it take for you to start feeling better after taking the capsules?

Were you able to decrease the drugs you were taking to treat your IC/PBS after starting the aloe? Yes No

Have you noticed an improvement in the condition of your hair and/or fingernails? Yes No

How many capsules of Desert Harvest Whole-Leaf Aloe Vera are you taking a day now?

How many times do you take the capsules per day?

What was the highest number of capsules you have taken per day?

Comments (please feel free to let us know your experiences, good or bad):

Thank you for taking the time to complete this brief survey. Your answers will help researchers better define this devastating disease and hopefully find better treatments and eventually a cure.

Regards,
Elaine Geisler
Clinical Nurse Researcher
Desert Harvest


Desert Harvest

20070 Roaming Drive
Colorado Springs, Colorado 80908
Toll Free: 800-222-3901
Fax: 719-598-8918
E-mail: support@desertharvest.com

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Desert Harvest does not make any health claims regarding any of its products. Even though we are committed to scientific research, we are not healthcare professionals. Our products are not intended to diagnose, treat, cure, or prevent any disease. As with any good health measures, it is important for an individual to be under the routine care of a physician and to follow the directions of qualified healthcare professionals. The suggestions, statements, and products on this website have not been evaluated by the Food and Drug Administation.