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Obstetric Fistula Survey
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
Have you ever heard of obstetric fistula?
Please select if you have heard of obstetric fistula before.
Yes
No
2
Do you know the type of fistula?
Please select if you are aware of the types of obstetric fistula.
Yes
No
3
Type of obstetric fistula
Please select the type of obstetric fistula you are aware of.
Rectovaginal Fistula (RVF)
Vesicovaginal Fistula (VVF)
Both
4
Do you know the signs/symptoms of obstetric fistula?
Please select if you are aware of the signs and symptoms of obstetric fistula.
Yes
No
5
Know the signs/symptoms of obstetric fistula
Please select the signs/symptoms of obstetric fistula that you are aware of.
Urinary incontinence
Irrita
6
Question 6
Please answer the following question.
Option 1
Option 2
Option 3
7
Question 7
Please rate the following on a scale of 1 to 10.
8
Question 8
Please provide a short answer to the following question.
9
Question 9
Please answer the following question.
Option A
Option B
Option C
10
Question 10
Please select the most appropriate option.
Option X
Option Y
Option Z
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