Urinary Health Trial Prescreen

About the Study

We are conducting a clinical trial to determine the efficacy of a dietary supplement drink mix designed to support urinary tract health by promoting the flushing of bacteria and other microorganisms from the urinary tract. To learn more about this trial and potential participation, please complete the form below!

Trial Overview

No in-person trial visits
Duration ~6 months
Track urinary health measures
Daily time commitment ~5 minutes
Earn up to $500!

Please complete this section expressing your interest in trial participation.

First Name

Last Name

Date of Birth

Email Address

Sex (assigned at birth)

FemaleMale

Do you currently reside in the United States?

YesNo

Are you interested in participating in this trial?

YesNo

If you click 'Yes' below, Bonafide Health will store your information (i.e., name, sex, date of birth, and email) in our secure database. If you express that you are not interested in participating in this study or if the research team deems you ineligible to enroll, Bonafide Health will still store your information should you express interest in or become eligible for this or another clinical study. Do you consent to Bonafide Health storing your information in our database?

YesNo

The following questions will ask you about your Urinary Tract Infection (UTI) history.

1. Have you ever experienced a UTI?

YesNo

2. Do you currently have an active UTI?

YesNo

How severe are your symptoms for this UTI occurrence?

How impairing are these symptoms for you for this UTI occurrence?

	Not at all (0)	Little (1)	Moderate (2)	Severe (3)	Very Severe (4)
Impaired activities due to urgency of urination
Impaired activities due to pain while passing urine
Impaired activities due to frequency of urination
Impaired activities due to pain in the lower abdomen

Recurrent Urinary Tract Infection Symptom Scale - Section C (RUTISS)

The following questions are about your UTI symptoms, and UTI-related pain or discomfort in your lower abdomen, genitals and/or bladder.

Please indicate whether you have experienced the following symptoms related to UTI in the PAST 24 hours, and if so, how SEVERE they were:

0=Not present
1=Very mild
10=Extremely severe

	0	1	2	3	4	5	6	7	8	9	10
Needing to urinate more frequently than normal.
Needing to urinate more urgently or more suddenly than normal.
Feeling as though you have the urge to urinate despite having just urinated.
Urine with an unusually strong or unpleasant smell.
Cloudy urine.
Debris or floating particles in your urine.
Pain or burning sensation when you are urinating.
Pain or burning sensation in the 30 minutes after urinating.
Pain or discomfort in your lower back.
Pain or discomfort in your side/flank.
Pain or discomfort radiating down into your legs.

3. What is the approximate date of your most recent UTI? If you are actively having a UTI, please recall the previous one you had.

4. In the past 6 months, how many UTIs have you experienced?

5. In the past 12 months how many UTIs have you experienced?

6. At what age did you start experiencing UTIs?

7. Do your UTIs tend to occur in a pattern (e.g., after sex, during your period, after increased physical activity)?

YesNo

If other, please explain

From External Database

Conditionally Eligible Math

	Not at all (0)	Mild (1)	Moderate (2)	Strong (3)	Very Strong (4)
Urgency of urination
Pain or burning when passing urine
Frequency of urination
Pain in lower abdomen