Peyronie Disease Society Verapamamil survey

              peyronies disease society

Survey on Topical or Transdermal Verapamil

This survey is only for those that have had used some form of topical Verapamil.

This information will be used to inform patients and urologists.

No identifying information will be released on this survey.

Please take this survey only once!

1.  Have you ever used topical or transdermal Verapamil

     Yes
     No

IF YES, Continue

2. For the purposes of this question, improvement or worsening is defined as change in erectile functioning or as an increase or decrease in deformity (bend, curve, indentation, hour glass, length or girth)

Did you: Select 1

Greatly Improve
    Moderately improve
Slightly Improve
   No Change
    Slightly Worsen
    Moderately Worsen
   Greatly Worsen

3.   If you experienced improvement or worsening, what changed (check all that apply)
       No change
       Bend, curve, or indentation
       Length or girth
       Erections

4. How long did you have PD prior to starting the topical Verapamil ?
       1 to 6 months
       6 to 12 months
       12 to 18 months
       18 to 24 months
       greater than 24 months

5. How long did you use topical verapamil?

       1-3 months
     4-6 months
     7-9 months
   10-12
     More than 12

6. What was the source of the topical Verapamil
        PDLabs
        Talon (Sheppherd)
        Other

7. How long did your source tell you it takes before you notice ANY KIND OF results from their medication?

     write in answer

8. To validate the integrity of this survey, please type your forum screen name (only for PDS members)
(This is only to assure the survey is only filled out once and that only members participated. this piece of information will not be saved or compiled)

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