Name
What were you treated for?
Of your treatment options, which did you have done?
Did the treatment meet or exceed your expectations?
How would you rate your condition PRIOR to treatment?
How would you rate your condition AFTER treatment?
How would you rate the results of your treatment?
If you were treated with a nerve test, are you interested in learning more about and scheduling the surgery?
Would you like to leave any Comments?
Can Southwest Urology Associates use the information you provided as a resource for other patients on our website?
How would you like to be identified?
Would you be interested in discussing your experience and outcomes with other patients?
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