Symptom Index from American Urological Association
Symptoms over past month	Never	Less than 1 time in 5	Less than half the time	About half the time	More than half	Almost always
Sensation of not emptying the bladder completely after urinating	0	1	2	3	4	5
Had to urinate within two hours of a previous urination	0	1	2	3	4	5
Needed to stop and start again several times while urinating	0	1	2	3	4	5
Had a weak urinary stream	0	1	2	3	4	5
Needed to strain to urinate	0	1	2	3	4	5
Number of times needed to urinate during bedtime at night	0	1 times	2 times	3 times	4 times	5 times

Circle appropriate number. Totals of: 7 or less = mild symptoms; 8-19 = moderate; 20-35 = severe.