1. How did you learn about this study?
Internet – Facebook/InstagramInternet – Web Search/BrowsingPhysician ReferralFriend/FamilyOther
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2. Please enter your zip/postal code so we can find your nearest study location(s):
3. If you qualify and decide to join the study, would you be willing and able to travel to this location approximately 11 times over a 5-year period?
YesNo
4. Are you male and at least 45 years of age?
5. Are you currently living with any of the following signs or symptoms of an enlarged prostate (BPH)? Please select all that apply:
Frequent need to urinate during the day and at nightWeak or slow urinary streamA sense that you cannot completely empty your bladderDifficulty or delay in starting urinationUrgent feeling of needing to urinateA urinary stream that stops and startsNone of the above
6. Have you previously had prostate surgery, or other invasive treatment to the prostate?
YesNoNot sure
7. Have you ever been diagnosed as having prostate cancer or bladder cancer?
8. The purpose of the BREEZE Clinical Study is to evaluate an investigational treatment (the Zenflow Spring® System). Are you willing to talk with a urology physician about this minimally invasive procedure to treat your BPH (enlarged prostate) symptoms?
Please enter your zip/postal code so we can find your nearest study location(s)
Based on your zip/postal code, the following BREEZE Clinical Study location(s) have been found in your area. Please select the location that is most convenient for you.
Your name City State/Province
Phone
Your email
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