Benign Prostatic Hyperplasia (BPH) – GoodpillRx

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Men
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- Low Testosterone
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- SKIN
- Hair
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- Pain
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Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

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Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
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- SKIN
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- Weight Loss
- Hair
- Migraine
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- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Goodpillrx Pharmacy's Telehealth Dept Offers Prescriptions By U.S. Licensed Doctors

Men
- SEX
- Low Testosterone
  - Lab Testing
- SKIN
- Hair
- Anti-Aging Kits
- Pain
- Weight Loss
- Anxiety
- Migraine
- Lab Test Kits
- More
Women
- Sex
- Hormones
- Women’s Fertility
- SKIN
- Thyroid
- Weight Loss
- Hair
- Migraine
- Lab Test Kits
- Pain
- Anxiety
Pets
- Dogs
- Cats
- Horses
Lab Testing
Active Aging
Treatments
Therapies
Covid-19
Latest Medications

Benign Prostatic Hyperplasia (BPH)

"*" indicates required fields

Name*

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

What is your date of birth?*

MM slash DD slash YYYY

What is your height?*

What is your weight?*

What is your gender?*

Male

Female

Are you currently breastfeeding, currently pregnant, or may become pregnant in the near future?*

Yes

No

Not sure

Please list all medications prescribed to you even if you don't take them every day. Include vitamins, and dietary supplements. Enter medicines including name, dose, frequency, and reason for taking.*

Please list your allergies, including any allergies to medications.*

Have you been diagnosed with benign prostatic hyperplasia (BPH)?*

Yes

No

How often have you had the sensation of not completely emtying your bladder after you finished urinating?*

Not at all

Less than one in five times

Less than one half of the time

About one half of the time

More than one half of the time

Almost always

How often have you had to urinate again less than two hours after you finished urinating?*

Not at all

Less than one in five times

Less than one half of the time

About one half of the time

More than one half of the time

Almost always

How often have you found that you stopped and started again when urinating?*

Not at all

Less than one in five times

Less than one half of the time

About one half of the time

More than one half of the time

Almost always

How often have you found it difficult to postpone urination?*

Not at all

Less than one in five times

Less than one half of the time

About one half of the time

More than one half of the time

Almost always

How often have you had a weak urinary stream?*

Not at all

Less than one in five times

Less than one half of the time

About one half of the time

More than one half of the time

Almost always

How often have you had to push or strain to begin urination?*

Not at all

Less than one in five times

Less than one half of the time

About one half of the time

More than one half of the time

Almost always

How many times do you typically get up to urinate from the time you go to bed at night until the time you get up in the morning?*

None

1 time

2 times

3 times

4 times

5 or more times

Were you receiving treatment for this condition?*

Yes

No

What medication, dosage and frequency were taking?*

Did the treatment provide relief of symptoms?*

Yes

No

How bothersome are your symptoms?*

Mild

Moderate

Severe

Do you have any of the following?*

Blood in the urine

Elevated PSA

Painful urination

Incontinence

Urinary retention

Cataract surgery

Glaucoma surgery

Liver disease

Hypotension (low blood presure)

History of neurological disease

What was your diagnosis?*

Provide a recent heart rate and blood pressure measurement. This can be from a recent appointment (within the past 6 months) or you can have these measured for free at most local pharmacies such as CVS or Walgreens.*

Finally, is there anything else we should know?*

Yes

No

please briefly explain.*

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