This questionnaire will take about 30 minutes to complete.
Unfortunately, the questionnaire cannot be saved as partially complete and returned to for completion at a later date. To avoid the loss of data, you will need to complete the questionnaire in one sitting. Alternatively, if you would prefer to complete the questionnaire in hard copy please email us at firstname.lastname@example.org to request a copy to be sent to you by email.
To complete the survey in one sitting, it will be easier if you have all your medical information and treatment details to hand. Therefore we encourage you to gather the following information before you commence the questionnaire:
- Names and contact information for all your treating doctors (general practitioners, specialists, allied health professionals such as physiotherapists, psychologists, etc)
- Dates of your initial contact with doctors regarding your pelvic organ condition
- The nature of your diagnosis (for example, type of prolapse)
- Date or dates and location(s) of any of your surgeries
- Details of any documents you received explaining the surgery and/or the mesh product
- Your employment details (if applicable)
- Your annual income, or estimate, based on the last full year worked (if applicable)
Whilst it is not necessary to answer all the questions before you submit the questionnaire, providing as much information as possible will enable us to properly assess your claim.
Once again, thank you for your participation.
Step 1: Contact info and health cover