• General Patient Information

  • Patient Medical Histtake this questionnaire back to its original formory

  • Endometriosis Health Profile Questionaire

  • During the last 4 weeks, how often, because of your emdometriosis or pelvic pain, have you.....

  • During the last 4 weeks, how often, because of your endometriosis or pelvic pain, have you

  • During the last 4 weeks, how often, because of your endometriosis or pelvic pain, have you...

  • During the last 4 weeks, how often, because of your endometriosis or pelvic pain, have you ...

  • During the last 4 weeks, how often, because of your endometriosis or pelvic pain, have you ...

  • Health Questionnaire (EQ-5D-5L)

    Under each heading, please tick the ONE box that best describes your health TODAY
  • In order for us to assess your requirements and create a personal management plan, please list the top 3 goals you would like to achieve through attending the Hunters Hill Endometriosis and Pelvic Pain clinic

  • Thank you for completing this information. Your answers will be compiled and our Endometriosis nurse will contact you in the next few days to arrange your first clinic appointment.

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