During the last month, how often:  | 
                                                Not at all
                                                      | 
                                                Less than 1 time
                                                      | 
                                                Less than half the time  | 
                                                About half the time  | 
                                                More than half the time  | 
                                                Almost always
                                                      | 
                                            
                                            
                                                Check mark your answers and then add up the points  | 
                                                0  | 
                                                1  | 
                                                2  | 
                                                3  | 
                                                4  | 
                                                5  | 
                                            
                                            
                                                1. Have you had the sensation of not emptying your bladder completely after you have 
                                                    finished urinating?  | 
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                                                2. Had to urinate again within 2 hours?  | 
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                                                3. Had to stop and start several times?  | 
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                                                4. Was difficult to hold back urine; have to go now?  | 
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                                                5. Had a weak urinary stream?  | 
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                                                6. Had to strain to urinate?  | 
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                                                7. Number of times got up at night?  | 
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