IC / PBS Questionnaire

Interstitial Cystitis / Painful Bladder Syndrome is sometimes diagnosed as chronic pelvic pain, pelvic pain dysfunction (PFD) or nonbacterial prostatitis. We will use IC/PBS to represent all of these conditions.

The Desert Harvest IC/PBS Questionnaire is meant to be completed after you have used our Super-Strength Aloe Vera Capsules for at least two months.

We are gathering data on the IC/PBS customer population that will be shared with researchers and healthcare practitioners in order to better define how our Super-Strength Aloe Vera capsules are affecting these conditions.

You may choose to remain anonymous if you would like, but either way, your name will never be associated with the data collected. Desert Harvest Privacy Policy.

Upon completion of your participation as a thank you, we will send you a discount code worth 10% off your next purchase.

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:

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 (IC)
Hunner's Ulcers
Painful Bladder Syndrome (PBS/BPS)
Chronic Pelvic Pain (CPP)
Nonbacterial Prostatitis
Pelvic Floor Dysfunction
Vulvodynia
Fibromyalgia
Autoimmune / Rheumatoid
Migraines
Chronic fatigue syndrome
Endometriosis
Allergies
Lung disease / asthma
Skin condition
Cancer
Osteoarthritis
Cholesterol, heart disease
Diabetes
Digestive disorder
Multiple Sclerosis (MS)
Hair & Nails


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

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

If other, please specify:

Did you experience relief when taking Desert Harvest Super-Strength Aloe Vera capsules?
 Yes  No

How long were you taking Desert Harvest Super-Strength Aloe Vera capsules before you started experiencing relief?

Did Desert Harvest Super-Strength Aloe Vera reduce your urgency/frequency of urination?

Did Desert Harvest Super-Strength Aloe Vera reduce your pelvic pain?

Did Desert Harvest Super-Strength Aloe Vera reduce your urethral burning?

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

How many capsules of Desert Harvest Super-Strength Aloe Vera are you taking per day?

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


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