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CERVICAL CANCER QUESTIONNAIRE Name: Date of Birth: Height: Weight: Sex: M/F Tobacco Usage: Face Amount: Term 10 15 20 30 UL 1. When was ovarian cancer diagnosed? 2. Which stage of cervical cancer

How to fill out cervical cancer questionnaire

How to fill out a cervical cancer questionnaire:

1. Start by carefully reading the instructions provided with the questionnaire. This will give you an understanding of what information is required and how it should be presented.
2. Begin by providing your personal details such as your name, age, contact information, and any relevant medical history.
3. Answer the specific questions asked about your lifestyle, sexual history, and any symptoms or concerns you may have related to cervical cancer.
4. If there are any sections that aren't applicable to you, make sure to mark them as such or leave them blank.
5. Be as honest and detailed as possible when answering the questions. This will help healthcare professionals accurately assess your risk level for cervical cancer.
6. If you are unsure about how to answer a particular question, it is recommended to consult a healthcare professional for guidance.
7. Once you have completed the questionnaire, review your answers to ensure accuracy and completeness.
8. Submit the questionnaire as instructed, whether it is through an online platform, mailing it to a specific address, or handing it to your healthcare provider during a visit.

Who needs a cervical cancer questionnaire?

1. Women who have reached the recommended age for cervical cancer screening, typically starting at age 21 or as recommended by their healthcare provider.
2. Individuals who have exhibited symptoms such as abnormal bleeding, pelvic pain, or unusual discharge that could be associated with cervical cancer.
3. Those who have a high-risk sexual history, including multiple partners, early sexual activity, or previous sexually transmitted infections.
4. Individuals with a family history of cervical cancer or certain genetic conditions that increase their susceptibility to the disease.
5. Women who have not had regular cervical cancer screening or have missed their previous appointments.
6. Those who have received an abnormal Pap smear or HPV test result and require further evaluation.
7. Individuals who have been vaccinated against HPV but still require regular cervical cancer screening.

Remember, if you have any concerns or questions regarding cervical cancer or the questionnaire, it is always best to consult with a healthcare professional who can provide personalized guidance and support.

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