Congratulations on starting your journey towards relief with the Medtronic Bladder Control Therapy delivered by the NUROTM system! You are not alone as you walk this path. Both your clinician and Medtronic are here to support you along the way.

Please help us understand how overactive bladder is impacting your life today by answering the short survey below. Support Linksm representatives will ask you these same questions again a few times throughout your 12-week therapy to track your progress.

This questionnaire asks how much you have been bothered by selected bladder symptoms during the past week. Please select the answer that best describes the extent to which you were bothered by each symptom during the past week. There are no right or wrong answers.

Please be sure to answer every question.

0=Not at all, 1= A little bit, 2=Somewhat, 3=Quite a bit, 4=A great deal. 5=A very great deal

During the past week, how bothered were you by… 0 1 2 3 4 5
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We will be checking in with you by phone 3 times throughout your initial 12-week journey with the NURO therapy to understand your progress and get you connected with information and support to help you find relief.

All we need is the information below to get you started on your NURO therapy journey!

Patient Information

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Message and data rates may apply. Text STOP to 69301 to stop receiving Medtronic therapy reminders. Compatible carriers include: AT&T®, Sprint®, Boost®, Verizon Wireless,® U.S. Cellular®, T-Mobile®. Medtronic respects your right to privacy. T-Mobile® is not liable for delayed or undelivered messages. You can view our Privacy Policy here.

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  I (the patient or caregiver) am signing up for the Bladder Control Therapy delivered by the NURO system support program.


By completing and submitting this form, you are granting Medtronic permission to add your personal information, including your contact information and basic healthcare information, to its patient database, and to share that information with Medtronic representatives and healthcare providers as appropriate.

We may conduct analyses on information collected in order to make improvements to and provide training on our operations, products, services, and customer communications. Medtronic may de-identify data collected, combining it with data collected from other sources. Lastly, information provided may be shared with your physician for treatment considerations or other purposes.

You also agree to being contacted by Medtronic in the future by mail, telephone, or by non-password protected electronic communications, such as emails or text messages. Medtronic may exchange information with you regarding our products or services, inquire about your experience, or determine how Medtronic can support you through your journey.

Medtronic respects the confidentiality of your personal information. If at any time you wish to revoke all or part of this permission, you can email us at or send a request in writing to: Medtronic Patient Support, 7000 Central Ave NE, RCE 230, Minneapolis, MN 55432. This permission will expire 10 years after the date of your signature.

If you live in Maryland, the consent expires automatically in one year. We may contact you then to see if you would like to renew it. Rev.: 09-21-2015

  I agree*

Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.