Preliminary Diagnostic Questionnaire

These questionnaires allow us to determine the bedwetting alarm treatment suitability for your child’s bedwetting problem and to answer your various questions. It is not necessary to specify identifying details about the child, but only details that will allow us to study the problem and convey our reference to you.

Child name

Child age

Child gender:

Parent name

Mobile

Wets during sleep:

Wets during the day:

Wets every night:

Wets once or twice a week:

Has been dry for longer than 4 consecutive months in the past:

Depth of sleep:

Motivation to be dry:

Previous interventions:

Medical tests:

Family history of bedwetting:

Comment 1:

Comment 2: