Options for follow up: If you checked "Yes" on one or more items above, you may have a pelvic health dysfunction. Help is available! This survey is for adults of all genders to help determine if pelvic therapy or medical assistance might be able to improve their quality of life. Not all of the questions will be relevant to everybody. Check if YES Check if YES Check if YES Check if YES Take this form with you to your primary care provider or pelvic therapist (physical therapy or occupational therapy) to help them get a more thorough idea of what your concerns are. There's help and lots of hope for these concerns!