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Whole-Leaf Aloe Vera

IC/PBS Questionnaire

(This questionnaire is meant to be completed after you have used our Super-strength, Freeze-dried Aloe Vera Capsules for at least two months. 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 Super-Strength 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:

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):



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

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437 Dimmocks Mill Road, Suite 17B
P.O. Box 1412 ~ Hillsborough, NC 27278
Toll Free: 800-222-3901 | International Customers: 919-245-1853 | Fax: 919-245-1857
Email: 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 Administration.