Patient Stories

Personal Details

First name*

Last name*

E-mail*

Country*

Telephone

Patient Story

Before Treatment
Tell us about your pelvic floor issue(s) before treatment. What were your symptoms? How were your daily life and activities impacted? How long did you wait before talking to your doctor? What prompted you seek treatment?

Max 2,000 characters.

Treatment
Tell us about the diagnosis process and any recommended treatments. What treatment options did you try and what was the outcome?

Max 2,000 characters.

After Treatment
How has your life changed? What are you able to do now that you could not do before? Why would you recommend other women seek treatment?

Max 2,000 characters.

Media

Add a Photo or Video (optional)
If you want to share files with us that are over 10MB in size (like video files) please contact the IUGA Office.
Image requirements:

Maximum file size 10MB
Photo formats accepted: .jpg .gif .jpeg .png

Photo Guidance:

Send a headshot (can be taken with your camera or phone)
Have a friend or family member take your photo
Make sure the photo includes only you, with no one else in the picture

Consent

I give my permission for IUGA to use my story anonymously.

I give my permission for IUGA to use my story with my first name and country only.

I am willing to provide a media statement and give my permission for IUGA to contact me using the contact information provided in this form.

Developed by