📋 Pre-consultation Questionnaire: Endometriosis

Abdominal wall endometriosis: pain and quality of life assessment

This questionnaire assesses the impact of your abdominal wall endometriosis on your quality of life. It will be passed directly to Pr Dohan, Cochin IR to prepare your consultation.

👤 Personal information

📊 Pain assessment

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No impactMajor impact

💬 Additional information

📄 This questionnaire is meant to be completed at home, ahead of your consultation. Fill it in, then print it or save it as a PDF and bring it with you on the day of your appointment. Nothing is sent automatically. If you would like to send it in advance, you can email it yourself via Contact us (at your own responsibility).

For Pr Dohan · IR Cochin