With the            evaluation we will be able to provide information for just how we can end bedwetting with personal attention to your situation.

If you would like to receive free information click here.

With over 30 years of family counseling experience, Dr. & Mrs. Tom & Maggie Goupil are available to help you with any difficulties that may arise during the correction process.

If you have questions about our program or to set up payments that will fit your budget, please call us..

989-634-8400

Comments

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Contact Information

Name of person with problem Age Name of person filling this out Street Address City State Zip code You must enter either a phone number or E-mail address to get a response from the Center. Telephone number E-mail Address   Sex of enuretic _ male female daytime wetting _ yes no seen doctor about bedwetting _ yes no takes medicine for bedwetting _ yes no takes medicine for other problems _ yes no feels urgent need to urinate _ yes no deep sleeper _ yes no difficult to wake up _ yes no ever used a moisture alarm _ yes no ever signed up with a bedwetting program _ yes no ever had another company sales person come to your home _ yes no ever dry at night _ yes no slow starter in morning _ yes no short temper _ yes no over active during day _ yes no short attention span _ yes no school problems _ yes no drinks milk daily _ yes no have you tried any of the following: getting up at night _ yes no restricting liquids _ yes no offered rewards for not wetting _ yes no is bedroom on same level of house as your bedroom _ yes no what type of bed bunk _ single double twin water Quenn king urinary infection often. _ yes no diabetes _ yes no asthma _ yes no allergies _ yes no epilepsy _ yes no hearing problem _ yes no speech problem _ yes no any history of bedwetting in family _ yes no frequency of night time wetting every night 1 2 3 more then 3 person filling this out parent Parent Yourself family Friend Parents reason for wanting bedwetting problem corrected at this time

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