Questionnaire Instructions

Thank you so much for taking the time to fill out this questionnaire.  Remember, this questionnaire must be completed prior to your appointment at SIWSH.  Because we want to provide you with the best care possible, we need to know as much about your current symptoms as possible.  Because of that, this questionnaire is fairly extensive.  Once you start the questionnaire, you cannot save a partially completed questionnaire and return to finish it later; the entire questionnaire must be completed at once.  Therefore, make sure that you have a sufficient amount of time to finish the questionnaire before you begin.  We suggest setting aside at least an hour.
 
Questions denoted with an asterisk (*) must be answered in order to submit this questionnaire.  If a question does not apply to you (for example, if a question asks what type of hysterectomy you have had, and you have not had a hysterectomy), you may skip the question.  In the event that a required question denoted with an asterisk does not apply to you (for example, if a question asks you to list all surgeries you have had, and you have not had any surgeries), please put "N/A" in the space for your response.
 
Although it is fine to skip a question that absolutely does not apply to you, we ask you to skip as few questions as you can and be as thorough in your comments as possible.  As stated previously, our goal is to provide you with the best care possible, and having complete, accurate, and thorough responses from this questionnaire will help us do that.
 
Again, thank you so much for taking the time complete this questionnaire prior to your visit, and thank you for letting us participate in your care.

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