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font-weight: bold; } .cfb-flex { display: flex; align-items: flex-end; } .cfb-flex-2 { margin-left: 1.5rem; } .filter-select { font-size: 1rem; color: #939393; padding: .25rem .5rem; width: 400px; } .btn-filter { color: #555; font-weight: bold; cursor: pointer; } @media (max-width: 991px) { .cfb-flex { flex-direction: column; } .cfb-flex-1 { width: 100%; } .filter-select { width: 100%; } } </style> <div class="joomla-content"> <div id="system-message-container"> </div> <div class="item-page"> <div class="icons pull-right"> </div> <div class="blog-inner-social"></div> <section class="newpatients patients-overactive patients hcp"> <div class="block-showreel container bg-1-2-bowel" role="img" aria-label="A couple riding bikes in the mountains"> <h1 class="text-center white-text">Are your bowel incontinence symptoms disruptive to your daily activities? <br />Have the freedom to live your life!</h1> </div> <div class="block-million banner container" style="background-image: url('/../images/patients/50_million_people.jpg');" role="img" aria-label="~20 million adults in the United States suffer from bowel incontinence, also referred to as accidental bowel leakage"> <p>You are not alone.</p> <h1 class="bowel-head-1">~19 million</h1> <p>adults in the United States suffer from bowel incontinence, also referred to as accidental bowel leakage.<sup class="bowel-no-top"><b>1</b></sup></p> </div> <div class="block-what container patients-bowel"> <div class="container"> <h2>What Is Bowel Incontinence?</h2> <br /> <h4>Bowel incontinence, or accidental bowel leakage, is a condition where people get sudden urges to pass stool and experience leakage of stool before they make it to the restroom.</h4> </div> </div> <div class="block-symptoms container"> <h2>Bowel Incontinence Symptoms</h2> <strong>You may be suffering from bowel incontinence if:</strong> <div class="row"> <article role="img" aria-label="Fecal urgency icon"> <h2>Fecal Urgency</h2> <p>You experience sudden urges to pass stool</p> </article> <article style="display: none;"> <h2>Frequency</h2> <p>You go to the bathroom to urinate so often that it disrupts your life — typically to be more than 7 times a day</p> </article> <article role="img" aria-label="Urgency fecal incontinence icon"> <h2>Urgency Fecal Incontinence</h2> <p>You experience an inability to stop the urge to pass stool</p> </article> <article style="display: none;"> <h2>Nocturia</h2> <p>You are waking up more than 1 time per night because you need to urinate</p> </article> <article role="img" aria-label="Passive bowel incontinence icon"> <h2>Passive Bowel Incontinence</h2> <p>You experience leakage of stool with activity or without awareness</p> </article> </div> <div class="green-hr"> </div> <strong>Did you know that patients can suffer from dual incontinence? <br />Dual incontinence is when a patient is experiencing both bladder and bowel control symptoms.</strong> <div class="green-hr"> </div> </div> <div class="block-journey"> <article role="img" aria-label="Bowel incontinence patient care pathway"> <h2>Your journey to find the treatment solution that works for you</h2> <div> <h3><b>1</b>CONSULT WITH YOUR DOCTOR</h3> <ul> <li>Discuss your symptoms</li> <li>Start a baseline bowel diary</li> <li>Undergo recommended diagnostic tests</li> <li>Discuss treatment options</li> </ul> </div> <div> <h3><b>2</b>INITIAL TREATMENT</h3> <ul> <li>Diet changes</li> <li>Sphincter and pelvic floor exercises</li> <li>Over-the-counter antidiarrheal medications</li> <li>Pessary</li> </ul> </div> <figure role="img" aria-label="Doctor icon"><span></span> <div> <div><b>No symptom improvements?<br />Don’t give up!</b></div> <p>Follow up with your doctor to discuss advanced therapy options</p> </div> <em class="corner corner-top"></em> <em class="corner corner-bottom"></em> <em class="corner corner-top left"></em> <em class="corner corner-bottom left"></em></figure> <div> <h3><b>3</b>ADVANCED THERAPIES</h3> <ul> <li>Minimally Invasive <ul> <li><b>Sacral Neuromodulation</b></li> </ul> </li> <li>Invasive <ul> <li>Surgical Sphincter Repair</li> </ul> </li> </ul> </div> <!-- <div class="figure-triangle"> </div> --> <div class="figure-triangle-svg"><img src="/images/patients/triangle.svg" alt="" /></div> </article> <article> <h2>Bowel Incontinence<br />Patient Care Pathway</h2> <p>Your doctor and his or her clinical team will follow a patient care pathway, which is a roadmap of the different treatment options available to you. The pathway starts with conservative treatments and then moves on to the advanced therapies.</p> <div class="threatment4"><strong>1</strong> <strong>2</strong> <strong> </strong> <strong>3</strong> <h4>CONSULT WITH YOUR DOCTOR</h4> <h4>Initial<br />Treatment</h4> <h4>follow up with<br />Your doctor</h4> <h4>advanced Therapies</h4> </div> </article> </div> <div class="block-neuromodulation banner container" style="background-image: url('/images/patients/What_is_Sacral_Neuromodulation.jpg'); background-size: cover;"> <div class="row neuro-block"> <div class="col"> <h2>What Is Sacral Neuromodulation?</h2> <p>Sacral Neuromodulation is a therapy that provides gentle stimulation to the nerves that communicate between the brain and the bladder and bowel. This advanced therapy helps restore normal communication, which can result in symptom improvement.</p> <a class="btn btn-outline btn-outline-success" href="/patients/about-axonics-therapy/axonics-therapy">CLICK HERE TO LEARN MORE</a></div> <div class="col"><!-- <div class="item-scale"> <div class="box-pie"> <svg xmlns="http://www.w3.org/2000/svg" width="270" height="270" viewBox="0 0 270 270"> <g> <g> <path fill="#dfdfdf" d="M134.834 8.95c69.588 0 126 56.413 126 126 0 69.589-56.412 126-126 126s-126-56.411-126-126c0-69.587 56.412-126 126-126z" /> </g> <g> <path fill="#8CC63F" d="M134.947 134.948V0c74.53 0 134.948 60.418 134.948 134.948s-60.418 134.948-134.948 134.948S0 209.477 0 134.948C0 75.324 36.54 25.03 93.246 6.605z" /> </g> </g> </svg> <div class="text-pie"> <span>94</span>% </div> </div> <img src="/images/hcp/pie/green/shadow.svg" alt="shadow" class="shadow_pie" /> <p> of patients were satisfied with their therapy<sup style="color: #fff">3</sup> </p> </div> --></div> </div> </div> <div class="block-experts"> <h2>Hear From the Experts</h2> <article class="containerex"> <figure><img src="/images/patients/experts-img-1.png" alt="Rebecca McCrery, MD, FPMRS" /></figure> <strong>Rebecca McCrery, MD, FPMRS<span>Urogynecologist</span></strong> <section class="accordion-block"> <div class="accordion-button">What options do patients have if they suffer from bowel (fecal) incontinence?</div> <div class="accordion-panel"><span> If we think overactive bladder is a hard thing for patients to bring up with a physician, fecal incontinence is even worse. Nobody really wants to bring up the fact that they’re accidentally passing stool. That’s a hard one for people to even bring up with anybody. <br /><br />We’ve had limited strategies to treat the problem, so we’ll often start with pelvic floor exercises, behavioral modifications, and optimizing fiber. Beyond that, our treatment options have historically been limited. It’s been a challenging condition from a standpoint of getting patients to talk about it. Sacral Neuromodulation is a great proven, long-term treatment option for these patients.</span></div> <div class="accordion-button">How important is the patient care pathway?</div> <div class="accordion-panel"><span> I think it’s really helpful if patients are familiar with the variety of treatment options up front. I think oftentimes, patients will stop seeking care for this problem because it doesn’t seem like there are any other options left. It’s really helpful to give a patient an idea of where we might be going early on, so that they recognize, “Hey, there’s a reason to come back. There’s a reason to continue this. Just because I didn’t get better with step one, doesn’t mean that there’s not another option for me.” </span></div> </section> </article> </div> <div class="block-solution banner container keyfob" style="background-image: url('/images/patients/solution_background-2.jpg');" role="img" aria-label="A patient putting the Axonics remote into their pocket"> <h2>There is a solution for you.</h2> <p>The good news is that there are bowel incontinence treatment options for controlling your symptoms. Axonics Therapy is an advanced solution to treat your <a href="/patients/about-your-symptoms/bowel-incontinence">bowel incontinence symptoms</a>. This therapy is a clinically proven solution to help people regain bowel control.<sup>2</sup></p> <a class="btn btn-outline btn-outline-success btn-outline-success--big" href="/patients/about-axonics-therapy/axonics-therapy">LEARN MORE ABOUT AXONICS THERAPY</a></div> <div class="real-stories"> <div class=""> <h2 class="white-text">Real stories. Real results.</h2> </div> <div class="real-stories_row"> <div class="real-stories_col"> <div class="real-stories_item"> <div class="real-stories_item-photo"><img src="/images/patients/real-stories-1.png" alt="Doris K." /></div> <div class="real-stories_item-text"> <div><span><span class="text-bold">Doris K.</span> <br />71 years old<br /><br /></span></div> <div class="box-quote-text">I adjusted my whole life by<br />limiting myself from drinking<br />and eating. Now I don’t have to.</div> </div> </div> </div> <div class="real-stories_col">Doris had suffered with overactive bladder and bowel symptoms since 1987. “The thing that stands out in my mind the most is that this has gone on for so many years and I had to adjust my whole life.” Finally, with <a href="/patients/about-axonics-therapy/axonics-therapy">Sacral Neuromodulation therapy from Axonics</a>, Doris got her symptoms under control and was able to say “goodbye” to wearing pads!</div> </div> <div class=""><a class="btn btn-outline btn-outline-light btn--black-text btn-stories" href="/patients/about-axonics-therapy/patient-stories">SEE WHAT OTHERS ARE SAYING</a></div> </div> <section class="home-join" style="background-size: cover; background: url('/images/patients/newpatients/home-axonics-join.jpg');"> <div class="home-join-block"> <h2>Be Strengthened. Be Supported.</h2> <p>Would you like to connect with someone who understands the unique<br />challenges of living with bowel dysfunction?</p> <div class="ptb3"><a class="btn btn-contacts btn-contacts--white-text btn-connect" href="/patients/resources-patients/connect-with-an-ambassador">Connect with an Axonics Ambassador</a></div> </div> </section> <style> fieldset, form, label, legend { margin: 0; padding: 0; border: 0; font-size: 100%; font: inherit; vertical-align: baseline; } small { font-size: .8em; } .quiz-layout { width: 100%; max-width: 960px; min-height: 517px; margin: 0 auto; padding: 1rem; background-color: #ffffff; color: #474e57; text-align: left; } .quiz-wrap form {} .quiz-wrap input[type="checkbox"], .quiz-wrap input[type="radio"] { margin: .25rem; } .quiz-wrap input[type="submit"] { width: 100%; font-size: 1rem; line-height: 1; margin-top: .5rem; padding: .5rem 1rem; border: 0px transparent; border-radius: .25rem; background-color: #474e57; color: #ffffff; font-weight: bold; cursor: pointer; } input[type="submit"]:hover { background-color: #6d737c; } .quiz-wrap .progress-bar { width: 100%; height: 5px; background-color: #e9e9e9; } .quiz-wrap .progress { height: 100%; background-color: #abd47d; width: 0; transition: width 0.2s ease-in-out; } .quiz-wrap fieldset { margin: 1rem 0 0; } .quiz-wrap fieldset legend { display: block; margin: 0 0 0.5rem; line-height: 1.2; } .quiz-wrap fieldset label { display: block; margin: 0 0 2px 0; line-height: 1; font-weight: bold; color: #ffffff; padding: .5rem; background-color: #474e57; border-radius: .25rem; } .quiz-wrap fieldset label:hover { background-color: #4f5761; user-select: none; cursor: pointer; transition: 0.1s ease-in; } .quiz-wrap fieldset label.label-selected { background-color: #6d737c; transition: 0.1s ease-in; } .quiz-wrap fieldset .btn-wrap { display: flex; justify-content: space-between; align-items: center; margin-top: .5rem; } .quiz-wrap button { font-weight: bold; font-size: 1rem; border: 0px none; background-color: transparent; background-size: 1rem; line-height: 1; background-repeat: no-repeat; border-radius: .25rem; } .quiz-wrap .backFieldset { color: #abd47d; background-image: url('/images/back-arrow.png'); padding: .5rem .5rem .5rem 1.75rem; background-position: .5rem .5rem; } .quiz-wrap .backFieldset:hover { background-color: #efefef; cursor: pointer; transition: 0.2s ease-in-out; } .quiz-wrap .nextFieldset { background-color: #abd47d; color: #ffffff; background-image: url('/images/next-arrow-white.png'); padding: .5rem 1.75rem .5rem .5rem; background-position: calc(100% - .5rem) .5rem; } .quiz-wrap .nextFieldset:hover { background-color: #bbe28f; cursor: pointer; transition: 0.2s ease-in-out; } .quiz-wrap .nextFieldset:disabled { visibility: hidden; } .survey-hidden-fields .group { background-color: #efefef; margin-top: .5rem; padding: .5rem; line-height: 1; } .survey-special { visibility: hidden; } .quiz-wrap span.input-label { display: inline-block; min-width: 180px; max-width: 50%; } .quiz-wrap span.input-label + input { min-width: 45%; } .quiz-wrap fieldset.survey-contact-details {} .quiz-wrap fieldset.survey-contact-details label, .quiz-wrap fieldset.survey-contact-details label:hover, .quiz-wrap fieldset.survey-contact-details label.label-selected { background-color: transparent; user-select: inherit; cursor: inherit; } .quiz-wrap fieldset.survey-contact-details label { font-size: .75rem; padding: 0; margin: 0; color: inherit; } .quiz-wrap fieldset.survey-contact-details label input { width: 100%; font-size: .85rem; padding: .25rem .5rem; border: 1px solid #cccccc; border-radius: .25rem; margin: .25rem 0 .5rem; } .privacy-modal { position: fixed; top: 0; left: 0; align-items: flex-start; justify-content: center; width: 100%; height: 100vh; background-color: rgb(0 0 0 / 59%); overflow: scroll; } .privacy-modal .modal-content { font-size: .75rem; display: block; background-color: #ffffff; width: auto; max-width: 720px; min-width: 300px; padding: 1.25rem 1.25rem; margin: 2rem auto; border-radius: 0.5rem; } .privacy-modal .modal-content h3 { font-size: 1rem; border-bottom: 1px solid gray; padding-bottom: .75rem; } .privacy-modal .modal-content p, .privacy-modal .modal-content ul li { font-size: inherit; } .privacy-modal.visible { display: flex !important; z-index: 999999; } @media only screen and (max-width: 900px) { html { font-size: 18px; } } @media only screen and (max-width: 570px) { html { font-size: 16px; } } </style> <div class="container" style="margin-top: 3rem;"> <h2 id="take-the-bladder-survey" style="text-align: center;">Take The Quiz. Find A Specialist.</h2> <!-- QUIZ --> <div class="quiz-layout"> <div class="quiz-wrap"> <div class="progress-bar"> <div class="progress"></div> </div> <form method="post" action="https://findrealrelief.axonics.com/surveys/quiz.php" onsubmit="return submitForm(this);"> <fieldset class="survey-bladder-symptoms"> <legend>Do you experience any of the following bowel and/or bladder control symptoms? <br><small>(Choose all that apply)</small></legend> <label for="frequentUrination"> <input type="checkbox" id="frequentUrination" name="bladder_symptoms[]" value="Frequent urination" autocomplete="off"> Frequent urination </label> <label for="strongUrge"> <input type="checkbox" id="strongUrge" name="bladder_symptoms[]" value="Sudden or strong urge to urinate" autocomplete="off"> Sudden or strong urge to urinate </label> <label for="leakageNoWarning"> <input type="checkbox" id="leakageNoWarning" name="bladder_symptoms[]" value="Urine leakage with little or no warning" autocomplete="off"> Urine leakage with little or no warning </label> <label for="leakageExertion"> <input type="checkbox" id="leakageExertion" name="bladder_symptoms[]" value="Urine leakage with exertion (eg, laughing, sneezing, exercise)" autocomplete="off"> Urine leakage with exertion (eg, laughing, sneezing, exercise) </label> <label for="incompleteEmptying"> <input type="checkbox" id="incompleteEmptying" name="bladder_symptoms[]" value="Incomplete emptying of the bladder" autocomplete="off"> Incomplete emptying of the bladder </label> <label for="bowelLeakage"> <input type="checkbox" id="bowelLeakage" name="bladder_symptoms[]" value="Bowel Leakage" autocomplete="off"> Bowel Leakage </label> <label for="noneOfTheAbove1"> <input type="checkbox" id="noneOfTheAbove1" name="bladder_symptoms[]" value="None of the above" autocomplete="off"> None of the above </label> <div class="btn-wrap"> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-bladder-symptoms-duration"> <legend>How long have you had bladder control symptoms?</legend> <label for="LessThan6Months" > <input type="radio" id="LessThan6Months" name="bladder_symptoms_duration" value="Less than 6 months" autocomplete="off"> Less than 6 months </label> <label for="6To12Months" > <input type="radio" id="6To12Months" name="bladder_symptoms_duration" value="6 to 12 months" autocomplete="off"> 6 to 12 months </label> <label for="Between1And5Years" > <input type="radio" id="Between1And5Years" name="bladder_symptoms_duration" value="Between 1 and 5 years" autocomplete="off"> Between 1 and 5 years </label> <label for="MoreThan5Years" > <input type="radio" id="MoreThan5Years" name="bladder_symptoms_duration" value="More than 5 years" autocomplete="off"> More than 5 years </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-quality-of-life"> <legend>How much do your bladder control symptoms affect your quality of life?</legend> <label for="verySeverely"> <input type="radio" id="verySeverely" name="quality_of_life" value="Very severely" autocomplete="off"> Very severely </label> <label for="severely"> <input type="radio" id="severely" name="quality_of_life" value="Severely" autocomplete="off"> Severely </label> <label for="moderately"> <input type="radio" id="moderately" name="quality_of_life" value="Moderately" autocomplete="off"> Moderately </label> <label for="slightly"> <input type="radio" id="slightly" name="quality_of_life" value="Slightly" autocomplete="off"> Slightly </label> <label for="noEffect"> <input type="radio" id="noEffect" name="quality_of_life" value="No effect" autocomplete="off"> No effect </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-has-doctor-diagnosed-you"> <legend>Has a doctor ever diagnosed you with any of the following? <br><small>(Choose all that apply)</small></legend> <label for="overactiveBladder"> <input type="checkbox" id="overactiveBladder" name="has_doctor_diagnosed_you[]" value="Overactive bladder (OAB)" autocomplete="off"> Overactive bladder (OAB) </label> <label for="urgeUrinaryIncontinence"> <input type="checkbox" id="urgeUrinaryIncontinence" name="has_doctor_diagnosed_you[]" value="Urge urinary incontinence (UUI)" autocomplete="off"> Urge urinary incontinence (UUI) </label> <label for="stressUrinaryIncontinence"> <input type="checkbox" id="stressUrinaryIncontinence" name="has_doctor_diagnosed_you[]" value="Stress urinary incontinence (SUI)" autocomplete="off"> Stress urinary incontinence (SUI) </label> <label for="urinaryRetention"> <input type="checkbox" id="urinaryRetention" name="has_doctor_diagnosed_you[]" value="Urinary retention (UR)" autocomplete="off"> Urinary retention (UR) </label> <label for="fecalIncontinence"> <input type="checkbox" id="fecalIncontinence" name="has_doctor_diagnosed_you[]" value="Fecal incontinence (FI)" autocomplete="off"> Fecal incontinence (FI) </label> <label for="noneOfTheAbove2"> <input type="checkbox" id="noneOfTheAbove2" name="has_doctor_diagnosed_you[]" value="None of the above" autocomplete="off"> None of the above </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-doctor-managing-issues"> <legend>Do you currently have a doctor managing your bladder control issues? <br><small>(If you have several, choose the one you consult most often.)</small></legend> <label for="primaryCareDoctor"> <input type="radio" id="primaryCareDoctor" name="doctor_managing_issues" value="Primary care doctor" autocomplete="off"> Primary care doctor </label> <label for="obgyn"> <input type="radio" id="obgyn" name="doctor_managing_issues" value="OB/GYN" autocomplete="off"> OB/GYN </label> <label for="urologist"> <input type="radio" id="urologist" name="doctor_managing_issues" value="Urologist" autocomplete="off"> Urologist </label> <label for="urogynecologist"> <input type="radio" id="urogynecologist" name="doctor_managing_issues" value="Urogynecologist" autocomplete="off"> Urogynecologist </label> <label for="anotherDoctor"> <input type="radio" id="anotherDoctor" name="doctor_managing_issues" value="Another doctor" autocomplete="off"> Another doctor </label> <label for="noDoctorAtThisTime"> <input type="radio" id="noDoctorAtThisTime" name="doctor_managing_issues" value="I don't have a doctor at this time" autocomplete="off"> I don't have a doctor at this time </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-tried-treatments"> <legend>Have you ever tried any of the following treatments? <br><small>(Choose all that apply)</small></legend> <label for="lifestyleChanges"> <input type="checkbox" id="lifestyleChanges" name="tried_treatments[]" value="Lifestyle changes (eg, dietary changes, limiting or timing fluid intake)" autocomplete="off"> Lifestyle changes (eg, dietary changes, limiting or timing fluid intake) </label> <label for="pelvicExercises"> <input type="checkbox" id="pelvicExercises" name="tried_treatments[]" value="Pelvic floor exercises or pelvic physical therapy" autocomplete="off"> Pelvic floor exercises or pelvic physical therapy </label> <label for="sacralNeuromodulation"> <input type="checkbox" id="sacralNeuromodulation" name="tried_treatments[]" value="Sacral neuromodulation (SNM, eg, Axonics or InterStim)" autocomplete="off"> Sacral neuromodulation (SNM, eg, Axonics or InterStim) </label> <label for="pelvicSling"> <input type="checkbox" id="pelvicSling" name="tried_treatments[]" value="Pelvic sling or other surgical procedure" autocomplete="off"> Pelvic sling or other surgical procedure </label> <label for="botoxOab"> <input type="checkbox" id="botoxOab" name="tried_treatments[]" value="BOTOX for OAB" autocomplete="off"> BOTOX injections </label> <label for="treatmentsNone"> <input type="checkbox" id="treatmentsNone" name="tried_treatments[]" value="None of the above" autocomplete="off"> None of the above </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-how-old-are-you"> <legend>How old are you?</legend> <label for="17orYounger"> <input type="radio" id="17orYounger" name="how_old_are_you" value="17 or younger" autocomplete="off"> 17 or younger </label> <label for="18to34"> <input type="radio" id="18to34" name="how_old_are_you" value="18 to 34" autocomplete="off"> 18 to 34 </label> <label for="35to49"> <input type="radio" id="35to49" name="how_old_are_you" value="35 to 49" autocomplete="off"> 35 to 49 </label> <label for="50to64"> <input type="radio" id="50to64" name="how_old_are_you" value="50 to 64" autocomplete="off"> 50 to 64 </label> <label for="65to79"> <input type="radio" id="65to79" name="how_old_are_you" value="65 to 79" autocomplete="off"> 65 to 79 </label> <label for="80orOlder"> <input type="radio" id="80orOlder" name="how_old_are_you" value="80 or older" autocomplete="off"> 80 or older </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-gender"> <legend>What is your sex, as assigned at birth?</legend> <label for="male"> <input type="radio" id="male" name="gender" value="Male" autocomplete="off"> Male </label> <label for="female"> <input type="radio" id="female" name="gender" value="Female" autocomplete="off"> Female </label> <label for="notSay"> <input type="radio" id="notSay" name="gender" value="I prefer not to say" autocomplete="off"> I prefer not to say </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-insurance"> <legend>What type of insurance do you have?</legend> <label for="privateInsurance"> <input type="radio" id="privateInsurance" name="insurance" value="Private insurance (either employer-provided or self-purchased)" autocomplete="off"> Private insurance (either employer-provided or self-purchased) </label> <label for="medicare"> <input type="radio" id="medicare" name="insurance" value="Medicare or Medicare Advantage" autocomplete="off"> Medicare or Medicare Advantage </label> <label for="medicaid"> <input type="radio" id="medicaid" name="insurance" value="Medicaid or government-assisted program" autocomplete="off"> Medicaid or government-assisted program </label> <label for="triCare"> <input type="radio" id="triCare" name="insurance" value="TriCare/Veterans Affairs" autocomplete="off"> TriCare/Veterans Affairs </label> <label for="noInsurance"> <input type="radio" id="noInsurance" name="insurance" value="No insurance/self-pay" autocomplete="off"> No insurance/self-pay </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-currently-taking-prescription"> <legend>Are you currently taking prescription bladder control medication(s)?</legend> <!-- "No, I’ve never taken them" should jump to "How did you hear about us?" --> <label for="prescriptionYes"> <input type="radio" id="prescriptionYes" name="currently_taking_prescription" value="Yes" autocomplete="off"> Yes </label> <label for="prescriptionTried"> <input type="radio" id="prescriptionTried" name="currently_taking_prescription" value="No, but I have tried them in the past" autocomplete="off"> No, but I have tried them in the past </label> <label for="prescriptionNo"> <input type="radio" id="prescriptionNo" name="currently_taking_prescription" value="No, I have never taken them" autocomplete="off"> No, I’ve never taken them </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-how-many-prescriptions-tried"> <legend>How many prescription bladder control medications have you tried?</legend> <label for="howManyOne"> <input type="radio" id="howManyOne" name="how_many_prescriptions_tried" value="One" autocomplete="off"> One </label> <label for="howManyTwo"> <input type="radio" id="howManyTwo" name="how_many_prescriptions_tried" value="Two" autocomplete="off"> Two </label> <label for="howManyThreeMore"> <input type="radio" id="howManyThreeMore" name="how_many_prescriptions_tried" value="Three or more" autocomplete="off"> Three or more </label> <label for="noneOfTheAbove3"> <input type="radio" id="noneOfTheAbove3" name="how_many_prescriptions_tried" value="None of the above" autocomplete="off"> None of the above </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="why-stop-taking-medication"> <legend>Why did you stop taking your bladder control medication? <br><small>(Choose all that apply)</small></legend> <label for="neverWorked"> <input type="checkbox" id="neverWorked" name="why_stopped_medications[]" value="Never worked" autocomplete="off"> Never worked </label> <label for="notWorkWellEnough"> <input type="checkbox" id="notWorkWellEnough" name="why_stopped_medications[]" value="Did not work well enough" autocomplete="off"> Did not work well enough </label> <label for="stoppedWorking"> <input type="checkbox" id="stoppedWorking" name="why_stopped_medications[]" value="Stopped working" autocomplete="off"> Stopped working </label> <label for="sideEffects"> <input type="checkbox" id="sideEffects" name="why_stopped_medications[]" value="Side effects"> Side effects </label> <label for="costInsuranceIssues"> <input type="checkbox" id="costInsuranceIssues" name="why_stopped_medications[]" value="Cost/insurance issues" autocomplete="off"> Cost/insurance issues </label> <label for="medicationOther"> <input type="checkbox" id="medicationOther" name="why_stopped_medications[]" value="Other" autocomplete="off"> Other </label> <label for="noneOfTheAbove4"> <input type="checkbox" id="noneOfTheAbove4" name="why_stopped_medications[]" value="None of the above" autocomplete="off"> None of the above </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="how-did-you-hear-about-us"> <legend>How did you hear about us? <br><small>(Choose all that apply)</small></legend> <label for="tvAd"> <input type="checkbox" id="tvAd" name="heard_about_us[]" value="TV ad " autocomplete="off"> TV ad </label> <label for="internetFacebookInstagram"> <input type="checkbox" id="internetFacebookInstagram" name="heard_about_us[]" value="Internet - Facebook/Instagram" autocomplete="off"> Internet - Facebook/Instagram </label> <label for="internetWebSearchBrowsing"> <input type="checkbox" id="internetWebSearchBrowsing" name="heard_about_us[]" value="Internet - Web Search/Browsing" autocomplete="off"> Internet - Web Search/Browsing </label> <label for="doctorRecommendation"> <input type="checkbox" id="doctorRecommendation" name="heard_about_us[]" value="Doctor recommendation" autocomplete="off"> Doctor recommendation </label> <label for="familyMemberFriend"> <input type="checkbox" id="familyMemberFriend" name="heard_about_us[]" value="Family member/friend" autocomplete="off"> Family member/friend </label> <label for="youTube"> <input type="checkbox" id="youTube" name="heard_about_us[]" value="YouTube" autocomplete="off"> YouTube </label> <label for="heardOther"> <input type="checkbox" id="heardOther" name="heard_about_us[]" value="Other" autocomplete="off"> Other </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="good-time-to-call"> <legend>When is a good time for us to call you with more information about physician providers in your area? <br><small>(Choose all that apply)</small></legend> <label for="RightNow"> <input type="checkbox" id="RightNow" name="time_to_call[]" value="Right now and weekday business hours only" autocomplete="off"> Right now (weekday business hours only) </label> <label for="CallMorning"> <input type="checkbox" id="CallMorning" name="time_to_call[]" value="Morning 8 to 11am" autocomplete="off"> Morning (8 – 11am) </label> <label for="CallMidday"> <input type="checkbox" id="CallMidday" name="time_to_call[]" value="Midday 11 to 2pm" autocomplete="off"> Midday (11 – 2pm) </label> <label for="CallAfternoon"> <input type="checkbox" id="CallAfternoon" name="time_to_call[]" value="Afternoon 2 to 5pm" autocomplete="off"> Afternoon (2 – 5pm) </label> <label for="IWillCall"> <input type="checkbox" id="IWillCall" name="time_to_call[]" value="No preference" autocomplete="off"> No preference </label> <div class="btn-wrap"> <button class="backFieldset">Back</button> <button class="nextFieldset" disabled>Next</button> </div> </fieldset> <fieldset style="display:none;" class="survey-contact-details"> <legend>You're almost done! Share your contact details to see if you qualify</legend> <label for="firstName"> <span>First Name:</span> <input type="text" id="firstName" name="firstName" required> </label> <label for="lastName"> <span>Last Name:</span> <input type="text" id="lastName" name="lastName" required> </label> <label for="email"> <span>Email:</span> <input type="email" id="email" name="email" required> </label> <label for="phone"> <span>Phone:</span> <input type="text" id="phone" name="phone" required> </label> <label for="zipCode"> <span>Zip Code:</span> <input type="text" id="zipCode" name="zipCode" autocomplete="off" required> </label> <small>By clicking ‘See if I qualify’, I agree to the terms of the <a href="https://www.axonics.com/privacy-policy" id="open-modal">Privacy Policy</a> and agree that Axonics may contact me to discuss my condition and potential treatments for it and will use my personal information for that purpose, consistent with the Privacy Policy.</small> <!-- <div class="g-recaptcha" data-sitekey="6LexCD8nAAAAACWPJTXQhBArsqJB_v-nAHXy4zH2"></div> <span class="error-message" id="captcha-error" style="display: none; color: red; font-size: 12px; position: absolute; margin-left: 15px;"></span> --> <div class="btn-wrap"> <input id="submit-btn" type="submit" value="See if I qualify"> </div> </fieldset> <!-- <div style="display:none;" class="survey-special"> <label for="special"> Special, pleaseomit. <input type="text" id="special" name="survey-special" value=""> </label> </div> --> <div style="display:none;" class="survey-hidden-fields"> <input type="hidden" id="thanks_content_check" name="thanks_content_check" value=""> <input type="hidden" id="quizCapturedUrl" name="quizCapturedUrl" value=""> <input type="hidden" id="quizQualifiedUrl" name="quizQualifiedUrl" value=""> <input type="hidden" id="referrer" name="referrer" value=""> <input type="hidden" id="utmVar" name="utmVar" value=""> <input type="hidden" id="googleClickID" name="googleClickID" value=""> <input type="hidden" id="facebookClickID" name="facebookClickID" value=""> <input type="hidden" id="microsoftClickID" name="microsoftClickID" value=""> </div> </form> </div> <!-- quiz-wrap --> </div> <!-- END QUIZ --> </div> <div class="privacy-modal" style="display:none;"> <div class="modal-content"> <h3>Axonics® Privacy Policy</h3> <p>Axonics, Inc. has created this Privacy Policy to document and demonstrate our firm commitment to privacy. This Privacy Policy describes the ways in which Axonics and its affiliates, service providers, and subsidiaries (collectively, “Axonics,” “we,” “our,” or “us”) may collect, use, and disclose personal information obtained or gathered through the use of Axonics websites or services that link to this policy (the “Services”). By using the Services and/or disclosing personal information, you consent to the processing of your personal information as set forth in this Privacy Policy, which is incorporated into our Terms of Use. This Privacy Statement is intended for website users in the United States. We will not sell the personal information that you provide to us.</p> <p><strong>What Information Do We Collect?</strong></p> <p>There are various places on the Axonics website where you can elect or sign-up to receive information from Axonics. We may collect the following categories of personal information about you in connection with your use of the Services:</p> <p><span style="text-decoration: underline;">Information You Provide</span>: We and our Service providers collect personal information that you may voluntarily share when you use the Services, including, but not limited to, information about your:</p> <ul> <li><span style="text-decoration: underline;">Contact information</span>, such as your first name, last name, email address, address, phone number;</li> <li><span style="text-decoration: underline;">Demographic information</span>, including your age, birth date, and gender;</li> <li><span style="text-decoration: underline;">Professional information</span>, including your employment status, employer information, title, occupation, and professional affiliations;</li> <li><span style="text-decoration: underline;">Account information</span>, including your username and password;</li> <li><span style="text-decoration: underline;">Health information</span>, including your health status, diagnoses, treatments, and symptoms;</li> </ul> <p><span style="text-decoration: underline;">Information Automatically Collected From You</span>: We and our service providers may automatically collect certain information about you and your online activities when you use the Services. We may collect personal and non-personal information, including, but not limited to, your Internet Protocol address, general geographic location, browser type, operating system, the pages you view on the Services, the pages you view immediately before and after you access the Services, links you follow on our website, and the search terms you enter on the Services.</p> <p><strong>How Do We Use Your Information?</strong></p> <p>We may use the information we collect for a number of purposes, including:</p> <ul> <li>to provide you with products, services, or information you request;</li> <li>to provide you with information about the Services or required notices;</li> <li>to deliver marketing communications, promotional materials, or advertisements that may be of interest to you;</li> <li>to customize your experience when using the Services, such as by providing interactive or personalized elements on the Services and providing you with content based on your interests;</li> <li>to improve the Services, such as by better tailoring our content to our users’ needs and preferences;</li> <li>to generate and analyze statistics about your use of the Services;</li> <li>to answer your questions about the Services, or otherwise communicate with you about the Services;</li> <li>for our business purposes, such as monitoring and prevention of fraud, intellectual property infringement, violations of our Terms of Use, violations of law, or other potential misuse of the Services.</li> </ul> <p><strong>When and to Whom Do We Disclose Your Information?</strong></p> <p>The information that we collect from and about you may be used internally by Axonics and may also be disclosed:</p> <ul> <li>to third parties that provide services to us in connection with our business operations and that have agreed to keep the information confidential;</li> <li>to business partners who offer products or services jointly with us or with our subsidiaries or affiliates;</li> <li>as required by law, such as to comply with a subpoena or other legal process, or to comply with government reporting obligations;</li> <li>when we believe in good faith that disclosure is necessary (a) to protect our rights, the integrity of the Services, or your safety or the safety of others, or (b) to detect, prevent, or respond to fraud, intellectual property infringement, violations of our Terms of Use, violations of law, or other misuse of the Services; and</li> <li>to service providers, advisors, potential transactional partners, or other third parties in connection with the consideration, negotiation, or completion of a corporate transaction in which we are acquired by or merged with another company or we sell, liquidate, or transfer all or a portion of our assets.</li> </ul> <p><strong>Use of Cookies</strong></p> To enable us to provide customized and personalized services, we and our service providers use cookies and similar tools to store and sometimes track information about you. A cookie is a small amount of data that is sent to your browser from a Web server and stored on your computer. If you do not want the Services to collect information through the use of cookies, you can set your web browser to reject cookies. Each browser is different, so you should check your browser’s “Help” menu to learn how to change your cookie preferences. If you reject or block cookies from the Services, however, the Services may not function as intended. <p><strong>Use of Google Analytics</strong></p> Google Analytics uses cookies to track your interactions with our website and online Services. Google then collects that information and reports it back to us. For more information on Google Analytics, visit “HOW GOOGLE USES INFORMATION FROM SITES OR APPS THAT USE OUR SERVICES” located at: https://www.google.com/policies/privacy/partners/. <p><strong>Do Not Track Signals</strong></p> California law requires that we share how we respond to website browser “do not track” signals. We do not currently recognize or honor “do not track” signals or other mechanisms that provide a method to opt out of the collection of information across websites or other online services. If we do so in the future, we will describe how we do so in this Privacy Policy. Visit the following website, www.allaboutdnt.org, for more information. <p><strong>Your California Privacy Rights</strong></p> If you reside in California and have provided your personally identifiable information to us, you may request information once per calendar year about our disclosures of certain categories of your personally identifiable information to third parties for their direct marketing purposes. Such requests must be submitted to us in writing at <span id="cloakbeae8ca0fdfdc329f9ac5e8e5e3b71a3">This email address is being protected from spambots. You need JavaScript enabled to view it.</span><script type='text/javascript'> document.getElementById('cloakbeae8ca0fdfdc329f9ac5e8e5e3b71a3').innerHTML = ''; var prefix = 'ma' + 'il' + 'to'; var path = 'hr' + 'ef' + '='; var addybeae8ca0fdfdc329f9ac5e8e5e3b71a3 = 'legal' + '@'; addybeae8ca0fdfdc329f9ac5e8e5e3b71a3 = addybeae8ca0fdfdc329f9ac5e8e5e3b71a3 + 'axonics' + '.' + 'com'; var addy_textbeae8ca0fdfdc329f9ac5e8e5e3b71a3 = 'legal' + '@' + 'axonics' + '.' + 'com';document.getElementById('cloakbeae8ca0fdfdc329f9ac5e8e5e3b71a3').innerHTML += '<a ' + path + '\'' + prefix + ':' + addybeae8ca0fdfdc329f9ac5e8e5e3b71a3 + '\'>'+addy_textbeae8ca0fdfdc329f9ac5e8e5e3b71a3+'<\/a>'; </script>. <p><strong>Children's Information</strong></p> The Services are not intended for or directed to individuals under the age of thirteen (13). If a parent or guardian becomes aware that his or her child has directly provided us with personal information, please contact us by using the contact information below. <p><strong>Changes to This Privacy Policy</strong></p> We may update this Privacy Policy from time to time. If we update this Privacy Policy, we will notify you by posting a new Privacy Policy to this page. If we make a material change to our Privacy Policy, we will take reasonable steps to notify you, for example by posting a banner on the Services website, prior to putting the changes into effect. <p><strong>Contact Us</strong></p> <p>If you have any questions, please contact us at <span id="cloak660b8296e30f0cbef4f1021fd26c1eff">This email address is being protected from spambots. You need JavaScript enabled to view it.</span><script type='text/javascript'> document.getElementById('cloak660b8296e30f0cbef4f1021fd26c1eff').innerHTML = ''; var prefix = 'ma' + 'il' + 'to'; var path = 'hr' + 'ef' + '='; var addy660b8296e30f0cbef4f1021fd26c1eff = 'legal' + '@'; addy660b8296e30f0cbef4f1021fd26c1eff = addy660b8296e30f0cbef4f1021fd26c1eff + 'axonics' + '.' + 'com'; var addy_text660b8296e30f0cbef4f1021fd26c1eff = 'legal' + '@' + 'axonics' + '.' + 'com';document.getElementById('cloak660b8296e30f0cbef4f1021fd26c1eff').innerHTML += '<a ' + path + '\'' + prefix + ':' + addy660b8296e30f0cbef4f1021fd26c1eff + '\'>'+addy_text660b8296e30f0cbef4f1021fd26c1eff+'<\/a>'; </script>.</p> <p><strong>Effective Date:</strong> July 8, 2019</p> </div> </div> <!-- <script src="https://www.google.com/recaptcha/api.js" async defer></script> --> <script> function checkThanksContent() { // Assuming the checkboxes have name attributes "bladder_symptoms[]" and "has_doctor_diagnosed_you[]" const bladderSymptoms = document.querySelectorAll('input[name="bladder_symptoms[]"]:checked'); const diagnosed = document.querySelectorAll('input[name="has_doctor_diagnosed_you[]"]:checked'); let hasRequiredBladderSymptom = false; let hasRequiredDiagnosis = false; bladderSymptoms.forEach(item => { if (item.value === "Urine leakage with exertion (eg, laughing, sneezing, exercise)") { hasRequiredBladderSymptom = true; } }); diagnosed.forEach(item => { if (item.value === "Stress urinary incontinence (SUI)" || item.value === "None of the above") { hasRequiredDiagnosis = true; } }); const thanksContentCheck = document.querySelector("#thanks_content_check"); if (hasRequiredBladderSymptom || hasRequiredDiagnosis) { thanksContentCheck.value = "true"; } else { thanksContentCheck.value = "false"; } } // Trim, hyphenate, and lower case a string function trimHyphenLower(str) { str = str.trim().replace(/\s+/g, '-').toLowerCase(); return str; } // Get Google Ad UTM Variables function utmPassAlong() { const pathArray = window.location.search.split('&'); let newPathname = ""; for (i = 0; i < pathArray.length; i++) { if (pathArray[i].startsWith("utm_")) { newPathname += "&"; newPathname += pathArray[i]; } } return newPathname; } // Cookie Functions function setCookie(cname,cvalue,exdays) { const d = new Date(); d.setTime(d.getTime() + (exdays*24*60*60*1000)); let expires = "expires=" + d.toUTCString(); document.cookie = cname + "=" + cvalue + ";" + expires + ";path=/"; } function getCookie(cname) { let name = cname + "="; let decodedCookie = decodeURIComponent(document.cookie); let ca = decodedCookie.split(';'); for(let i = 0; i < ca.length; i++) { let c = ca[i]; while (c.charAt(0) == ' ') { c = c.substring(1); } if (c.indexOf(name) == 0) { return c.substring(name.length, c.length); } } return ""; } // Set referrer cookie function referrerCookie() { let refCookie = getCookie("axnx_referrer_cookie"); if (refCookie === "" || refCookie === undefined) { let site = location.protocol + '//' + location.host let docRef = document.referrer; if (docRef.startsWith(site) || docRef === "") { setCookie("axnx_referrer_cookie", "direct", 30); } else { setCookie("axnx_referrer_cookie", docRef, 30); } } } // Set UTM cookie function utmCookie() { let utmCookie = getCookie("axnx_utm_cookie"); if (utmCookie === "" || utmCookie === undefined) { let utms = utmPassAlong(); setCookie("axnx_utm_cookie", utms, 30); } } function insertHiddenFields() { let quizCapturedUrlInput = document.querySelector('#quizCapturedUrl'); let quizQualifiedUrlInput = document.querySelector('#quizQualifiedUrl'); let referrerInput = document.querySelector('#referrer'); let utmVarInput = document.querySelector('#utmVar'); let googleClickIDInput = document.querySelector('#googleClickID'); let facebookClickIDInput = document.querySelector('#facebookClickID'); let microsoftClickIDInput = document.querySelector('#microsoftClickID'); let quizCapturedUrl = "?captured_url=" + location.protocol + "//" + location.host + location.pathname; let quizQualifiedUrl = "&qualified_url=" + "https://www.axonics.com/patients/qualified"; let utmVar = ""; if (getCookie("axnx_utm_cookie").length <= 1) { let utmSource = ""; // &utm_source=" + trimHyphenLower(""); let utmMedium = ""; // &utm_medium=" + trimHyphenLower(""); let utmCampaign = "&utm_campaign=" + trimHyphenLower("axonics.com/patients"); let utmContent = ""; // "&utm_content=" + trimHyphenLower("none"); let utmTerm = ""; // "&utm_term=" + trimHyphenLower("none"); utmVar = utmSource + utmMedium + utmCampaign + utmContent + utmTerm; } else { utmVar = getCookie("axnx_utm_cookie"); } let referrer = "&referrer=" + getCookie("axnx_referrer_cookie"); function getClickID(vendor) { const searchArray = window.location.search.split('&'); let resultsGCLID = ""; for (i = 0; i < searchArray.length; i++) { if(i === 0) { // console.log('searchArray[0] = ' + searchArray[0]); let firstSearch = searchArray[0].substring(1); if (firstSearch.startsWith(vendor)) { resultsGCLID = firstSearch; break; } } else { if (searchArray[i].startsWith(vendor)) { resultsGCLID = searchArray[i]; break; } } } // console.log("GCLID = " + resultsGCLID); return resultsGCLID; } let googleClickID = "&" + (getClickID("gclid") ? getClickID("gclid") : "blank"); let facebookClickID = "&" + (getClickID("fbclid") ? getClickID("fbclid") : "blank"); let microsoftClickID = "&" + (getClickID("msclkid") ? getClickID("msclkid") : "blank"); quizCapturedUrlInput.value = quizCapturedUrl.slice(1); quizQualifiedUrlInput.value = quizQualifiedUrl.slice(1); referrerInput.value = referrer.slice(1); utmVarInput.value = utmVar.slice(1); googleClickIDInput.value = googleClickID.slice(1); facebookClickIDInput.value = facebookClickID.slice(1); microsoftClickIDInput.value = microsoftClickID.slice(1); } document.addEventListener('DOMContentLoaded', function() { // add "label-selected" to any label with a checked radio input var radioInputs = document.querySelectorAll('input[type="radio"]'); for (var i = 0; i < radioInputs.length; i++) { radioInputs[i].addEventListener('change', function() { if (this.checked) { // remove "label-selected" class from all parent label elements in the same set var parentLabels = document.querySelectorAll('input[name="' + this.name + '"]'); for (var j = 0; j < parentLabels.length; j++) { parentLabels[j].parentNode.classList.remove('label-selected'); } // add "label-selected" class to the parent label element of the selected radio input var parentLabel = this.parentNode; parentLabel.classList.add('label-selected'); } }); } var fieldsets = document.querySelectorAll('fieldset'); // General 'next' function function nextStep(currentFieldset, steps = 1) { let nextFieldset = currentFieldset; for (let i = 0; i < steps; i++) { nextFieldset = nextFieldset.nextElementSibling; if (nextFieldset == null) break; } currentFieldset.style.display = 'none'; if (nextFieldset) nextFieldset.style.display = 'block'; // update progress bar var progressBar = document.querySelector('.progress'); var completed = document.querySelectorAll('fieldset:not([style*="none"])'); var index = Array.prototype.indexOf.call(fieldsets, nextFieldset); progressBar.style.width = ((index + 1) / fieldsets.length) * 100 + '%'; } // General 'back' function function previousStep(currentFieldset, steps = 1) { let prevFieldset = currentFieldset; for (let i = 0; i < steps; i++) { prevFieldset = prevFieldset.previousElementSibling; if (prevFieldset == null) break; } currentFieldset.style.display = 'none'; if (prevFieldset) prevFieldset.style.display = 'block'; // update progress bar var progressBar = document.querySelector('.progress'); var completed = document.querySelectorAll('fieldset:not([style*="none"])'); var index = Array.prototype.indexOf.call(fieldsets, prevFieldset); progressBar.style.width = (index / fieldsets.length) * 100 + '%'; } // "next" button functionality var nextButtons = document.querySelectorAll('.nextFieldset'); for (let i = 0; i < nextButtons.length; i++) { nextButtons[i].addEventListener('click', function(event) { event.preventDefault(); let current_fs = this.parentNode.parentNode; nextStep(current_fs); }); } // "previous" button functionality var prevButtons = document.querySelectorAll('.backFieldset'); for (let i = 0; i < prevButtons.length; i++) { prevButtons[i].addEventListener('click', function(event) { event.preventDefault(); let current_fs = this.parentNode.parentNode; previousStep(current_fs); }); } // Enable "next" button as soon as at least one checkbox or radio button is clicked within the current fieldset for (let i = 0; i < fieldsets.length; i++) { let checkboxes = fieldsets[i].querySelectorAll('input[type="checkbox"]'); let radioButtons = fieldsets[i].querySelectorAll('input[type="radio"]'); let nextButton = fieldsets[i].querySelector('.nextFieldset'); // for checkboxes, just enable the next button when at least one checkbox is checked for (let j = 0; j < checkboxes.length; j++) { checkboxes[j].addEventListener('change', function() { let hasChecked = Array.from(checkboxes).some(checkbox => checkbox.checked); if (hasChecked) { nextButton.disabled = false; } else { nextButton.disabled = true; } }); } // for radio buttons, enable the next button and move to the next fieldset when a radio button is selected for (let j = 0; j < radioButtons.length; j++) { if (radioButtons[j].id === 'prescriptionNo') continue; // Skip 'prescriptionNo' here, we handle it separately radioButtons[j].addEventListener('change', function() { nextButton.disabled = false; let current_fs = radioButtons[j].parentNode.parentNode; nextStep(current_fs); }); } } // If prescriptionNo is selected, skip 2 fieldsets var prescriptionNo = document.querySelector('#prescriptionNo'); var medTriedRadioNone = document.querySelector('#noneOfTheAbove3'); var medWhyStoppedRadioNone = document.querySelector('#noneOfTheAbove4'); if (prescriptionNo) { prescriptionNo.addEventListener('change', function(event) { if (event.target.checked) { let current_fs = this.parentNode.parentNode; // Inputs to set on skipped fieldsets medTriedRadioNone.checked = true; medWhyStoppedRadioNone.checked = true; nextStep(current_fs, 3); } }); } var openModalButton = document.getElementById('open-modal'); // var closeModalButton = document.getElementById('close-modal'); var modal = document.querySelector('.privacy-modal'); // show modal when "Open Modal" button is clicked openModalButton.addEventListener('click', function(event) { event.preventDefault(); modal.classList.add('visible'); }); // hide modal when "Close Modal" button is clicked modal.addEventListener('click', function(event) { event.preventDefault(); modal.classList.remove('visible'); }); }); referrerCookie(); utmCookie(); insertHiddenFields(); // function executeRecaptcha(form) { // return new Promise((resolve) => { // grecaptcha.ready(function() { // grecaptcha.execute('6LexCD8nAAAAACWPJTXQhBArsqJB_v-nAHXy4zH2', {action: 'submit'}).then(function(token) { // // Add the token to a hidden form input // var input = document.createElement('input'); // input.type = 'hidden'; // input.name = 'g-recaptcha-response'; // input.value = token; // form.appendChild(input); // // Resolve the promise when finished // resolve(); // }).catch(function(error) { // console.log("An error occurred while executing reCAPTCHA: ", error); // }); // }); // }); // } // Function to handle reCAPTCHA verification // function handleRecaptcha(form) { // // Check if reCAPTCHA checkbox is checked and verified // var recaptchaResponse = grecaptcha.getResponse(); // var captchaError = form.querySelector('#captcha-error'); // if (!recaptchaResponse || recaptchaResponse === "") { // captchaError.textContent = "Please complete the reCAPTCHA challenge."; // captchaError.style.display = "inline"; // return false; // Prevent form submission // } else { // captchaError.style.display = "none"; // return true; // Proceed with other logic in the submit function // } // } function validateForm(form) { var firstName = form.querySelector('#firstName'); var lastName = form.querySelector('#lastName'); var zipCode = form.querySelector('#zipCode'); var email = form.querySelector('#email'); var phone = form.querySelector('#phone'); var namePattern = /^[a-zA-Z\u00C0-\u017F-' ]+$/; var zipPattern = /^\d{5}$/; var emailPattern = /^[^\s@]+@[^\s@]+\.[^\s@]+$/; var phonePattern = /^[+]?[\s.-]?[(]?\d{3}[)]?[\s.-]?\d{3}[\s.-]?\d{4}$/; firstName.setCustomValidity(namePattern.test(firstName.value) ? "" : "Invalid input: The first name you entered is not in an accepted format."); lastName.setCustomValidity(namePattern.test(lastName.value) ? "" : "Invalid input: The last name you entered is not in an accepted format."); zipCode.setCustomValidity(zipPattern.test(zipCode.value) ? "" : "Invalid zip code. Zip code should only contain 5 digits."); email.setCustomValidity(emailPattern.test(email.value) ? "" : "Invalid email. Please check the format of your email."); phone.setCustomValidity(phonePattern.test(phone.value) ? "" : "Invalid phone number. Please use a 10-digit phone number."); return form.checkValidity(); } function submitForm(form) { var submitButton = form.querySelector('#submit-btn'); if (submitButton.getAttribute('data-processing') === 'true') { return false; } else { checkThanksContent(); // var isValid = (validateForm(form) && handleRecaptcha(form)); var isValid = (validateForm(form)); if (!isValid) { console.log("Form not valid."); return false; } submitButton.setAttribute('data-processing', 'true'); submitButton.disabled = true; // // reCaptcha: Call the executeRecaptcha function // executeRecaptcha(form).then(function() { // // Submit the form once the reCAPTCHA has been executed // form.submit(); // }); return true; } } var fields = ['firstName', 'lastName', 'zipCode', 'email', 'phone']; fields.forEach(function(fieldId) { var inputField = document.querySelector('#' + fieldId); inputField.addEventListener('input', function() { this.setCustomValidity(''); }); inputField.addEventListener('blur', function() { validateForm(this.form); }); }); </script> <div class="container"> <div class="ptb2"> <p><b>References:</b></p> <p>1. Ditah I, Devaki P, Luma HN, et al. Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005-2010. Clin Gastroenterol Hepatol. 2014;12(4):636-43.e432. doi:10.1016/j.cgh.2013.07.020</p> <p>2. Pezzella A, McCrery R, Lane F, et al. Two-year outcomes of the ARTISAN-SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system. Neurourol Urodyn. 2021;40(2):714-721. doi:10.1002/nau.24615</p> </div> </div> </section> <p><style type="text/css"> .cta-take-quiz { display: flex; position: fixed; z-index: 999; bottom: 13rem; right: -105px; width: 255px; background-color: #f2b459; color: #fff; padding: .5rem 1rem; transform: rotate(-90deg); font-size: .85em; border-radius: 5px 5px 0 0; } .cta-take-quiz:hover { transition: .2s; background-color: #fac577; } .cta-take-quiz a { cursor: pointer; } .cta-take-quiz a:hover { color: #fff; } @media screen and (max-width: 768px) { .cta-take-quiz { bottom: 0; right: 0; width: auto; transform: initial; } } </style> <div class="cta-take-quiz"> <a href="#take-the-bladder-survey" class="gtm--take-the-quiz"><span>Take The Quiz. 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