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  2. 2016
  3. December
  4. W
  5. Women Healthcare
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Exit Survey
 
 
Hello: You are invited to participate in our survey [Women Health Care & Hygiene]. It will take approximately10 minutes to complete the questionnaire. Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions. Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
Contact Information
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
* Phone : 
* Email Address : 
* Country : 
 
 
 
* What is your date of birth?
MonthDayYear
  
 
 
 
* Do you have a personal physician?
 
Yes
 
No
 
Other
 
 
 
 
* What kind of physician is he/she?
 
Pediatrician
 
OB/GYN
 
General Practice
 
Other
 
 
 
 
* Hypothetically, if you need to be hospitalised, would you choose your Gynaecologist or your hospital first?
 
Gynaecologist
 
Hospital
 
Not Sure
 
Depends
 
 
 
* Would you switch hospitals on your physicianÂ’'s advice (from your preferred hospital)?
 
Yes, I rely on my physician's advice
 
No. I'm very happy with my current hospital
 
Depends on which hospital he is referring to
 
Other
 
 
 
 
* Have you been hospitalized for OB/Maternity?
 
Yes
 
No