PATIENT OSTOMY SURVEY 2014

1. PATIENT OSTOMY SURVEY CONSENT

 
You and your family members are important members of the surgical team. In order to help you safely care for yourself after your ostomy operation, you are being provided with the American College of Surgeons Osotmy Home Skills Kit.

We need your help to make sure that the Skills Kit prepares you to care for yourself or for a family member. We are asking you to complete a short survey about your care. You should complete the survey after your first follow-up office visit with your surgeon. This visit usually happens 7 to 14 days after your operation.

You have a choice to either complete the survey or not. If you choose not to complete the survey, no one will treat you differently.

Some information about the survey:
- It will take about 5 minutes of your time
-Answering this survey may not help you directly, but it may help people with an ostomy in the future.
-All survey answers will be seen only by the study investigator at the American College of Surgeons.
-Only the group resplonse will be reported (for example, the average time patient spent watching the DVD was 30 minutes).
-The group responses will help your surgical team know what else can be done to help you care for yourself after your operation.
-You can check the survey website for the updated summary of the responses.
1. Please enter your Ostomy Home Skills Kit ID number found on the box or on the printed survey:
*
2. I have read and understood this consent. (must check yes to proceed)
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