| PCOS Research Survey |
| ***Disclaimer***: OBGYN.net believes that personal privacy is of the utmost important. To preserve data integrity by preventing duplicate responses, we require you to enter your E-mail Address. All information submitted in this survey is for internal use only, and will not be distributed to any third parties without your consent. |
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E-mail Address: |
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| 1a) |
What is the reason for your most recent visit to the doctor? |
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| b) |
How long ago was your last visit to the doctor? |
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| 2a) |
Have you ever heard of polycystic ovary syndrome (PCOS)? |
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| 3a) |
If you have heard of PCOS or think you may have it, what is your biggest worry or concern? |
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| 4a) |
If you have not heard about PCOS, or are not really sure what it is, who or what would you consider the best place to learn more about it? |
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| 5a) |
How did you first learn about PCOS? |
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| 6a) |
How well do you consider yourself to be informed about PCOS? |
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| 7a) |
What is your age? |
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| 8a) |
Have you been pregnant before? |
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| b) |
If yes, how many times (including miscarriages)? |
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| c) |
Have you ever taken fertility medicine? |
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| d) |
If your PCOS could be safely helped by something else besides fertility drugs or birth control pills, would that interest you? |
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| 9a) |
Please enter your height and weight in Imperial (US) or Metric units:
Imperial - Height: ft in / Weight: lbs
Metric - Height: cm / Weight: kg
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| 10a) |
What emotion best describes your feelings about PCOS? |
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