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* 1. Gender

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* 2. Age

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* 3. Do you have a stoma

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* 4. If you answered no, are you a carer of a person with a stoma?

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* 5. The stoma is to collect-

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* 6. Would you like to meet other people with stomas and/or carers of people with stomas in our region in a support group environment?

T