NBA IKEJA WELFARE: Prostate and Cervical Cancer Screening Survey

NBA Ikeja Welfare Prostate & Cervical Screening Survey
Depending on your age and other factors, you may not have experience with some or all of the screenings listed. Regardless of screening history, it is important to be aware and in touch with the changes your body is experiencing
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
1. How much do you support or oppose the Cancer screening test ?

Strongly SupportSomewhat SupportNeither support nor opposeSomewhat opposeStrongly Oppose
2. Have you ever been diagnosed with cancer before?

YesNo
3. If you are experiencing any of the conditionsbelow, it is important to share them with your doctor. Select any symptoms youhave and capture any additional information in the options below

Change in bowel HabitsVaginal Discharge/OdurBlood DischargeDark stool and blood in stoolAbdominal painFatigueNone of the above
4. What is your gender?

MaleFemale
5. What is your age?

25 to 3435 to 4445 to 5455 to 6465 and Above
6. Would you be participating in the Cancer screening exercise organized by NBA IKEJA WELFARE on May 16th and 17th 2022?

YesNo
Should be Empty:

NBA Ikeja Welfare Prostate & Cervical Screening Survey