El Camino Hospital - Menopause Needs Assessment Question Title * 1. Please choose your age range: 39 and younger 40-44 45-49 50-54 55-59 60-64 65-70 70+ Question Title * 2. Which menopause topics are of most interest to you? Not interested at all Don’t know A little bit interested Very Interested How to manage hot flashes How to manage hot flashes Not interested at all How to manage hot flashes Don’t know How to manage hot flashes A little bit interested How to manage hot flashes Very Interested Diet, Exercise, Bone Health, and Weight Gain Diet, Exercise, Bone Health, and Weight Gain Not interested at all Diet, Exercise, Bone Health, and Weight Gain Don’t know Diet, Exercise, Bone Health, and Weight Gain A little bit interested Diet, Exercise, Bone Health, and Weight Gain Very Interested Hormone Replacement and Bioidenticals Hormone Replacement and Bioidenticals Not interested at all Hormone Replacement and Bioidenticals Don’t know Hormone Replacement and Bioidenticals A little bit interested Hormone Replacement and Bioidenticals Very Interested Urinary Tract Infections, Incontinence Urinary Tract Infections, Incontinence Not interested at all Urinary Tract Infections, Incontinence Don’t know Urinary Tract Infections, Incontinence A little bit interested Urinary Tract Infections, Incontinence Very Interested Sexual Desire, Vaginal Dryness Sexual Desire, Vaginal Dryness Not interested at all Sexual Desire, Vaginal Dryness Don’t know Sexual Desire, Vaginal Dryness A little bit interested Sexual Desire, Vaginal Dryness Very Interested Question Title * 3. How interested are you in attending a quarterly 1-hour educational session led by a doctor or nurse to understand latest research on managing menopause symptoms? Not interested at all Don’t know A little bit interested Very Interested Not interested at all Don’t know A little bit interested Very Interested Question Title * 4. What time would be best? (choose all that apply) Noon Evenings Weekends Question Title * 5. Would you be interested in participating in a webinar where you could call-in and listen to a menopause presentation and be able to ask questions? Not interested at all Don’t know A little bit interested Very Interested Not interested at all Don’t know A little bit interested Very Interested Question Title * 6. Would you be interested in viewing short (less than 10 minutes) on-line videos on various menopause topics that would be on an El Camino Hospital webpage dedicated to menopause topics? Not interested at all Don’t know A little bit interested Very Interested Not interested at all Don’t know A little bit interested Very Interested Question Title * 7. Would you be interested in attending a monthly in-person menopause support group which would be held at El Camino Hospital? Not interested at all Don’t know A little bit interested Very Interested Not interested at all Don’t know A little bit interested Very Interested Question Title * 8. Which location is most convenient? Los Gatos Mountain View Question Title * 9. Would you be interested in being part of an on-line support group and be able to ask specific questions to our medical experts about menopause issues? Not interested at all Don’t know A little bit interested Very Interested Not interested at all Don’t know A little bit interested Very Interested Question Title * 10. Would you be interested in receiving email updates about various menopause topics? Not interested at all Don’t know A little bit interested Very Interested Not interested at all Don’t know A little bit interested Very Interested Question Title * 11. Would you be interested in free educational materials on different menopause topics that you could download from the El Camino Hospital website? Not interested at all Don’t know A little bit interested Very interested Not interested at all Don’t know A little bit interested Very interested Question Title * 12. Would you be interested in a book on menopause? Not interested at all Don’t know A little bit interested Very interested Not interested at all Don’t know A little bit interested Very interested Question Title * 13. Would you like to receive future information on menopause lectures or events? Please provide your email address: Done