Page 1 of 1

Menstrual health questionnaire

Completing this will really help to contribute to the making of the film. We really want to make sure we get as many voices as possible. 
Thank you for taking time to help us. 
You can choose to keep the information you share anonymously. It will be seen by myself and the other filmmaker involved, some stats and answers may be used in the film but can be shared anonymously.

What age were you when you started struggling with your periods?

Which of these do you have?

Which of these do you have?

If other, please write further information below:

Have you got a diagnosis from a medical professional?

Have you got a diagnosis from a medical professional?
A
B
C

How long did it take to get a diagnosis?

Have you been on an NHS waiting list?

Have you been on an NHS waiting list?
A
B
C

If so, how long was it before you accessed treatment?

Have you had private healthcare treatment?

Have you had private healthcare treatment?
A
B
C

If so, was it affective for you?

If so, was it affective for you?
A
B
C

What treatment did you have?

How much did the treatment cost?

Have you had surgery?

Have you had surgery?
A
B
C

If so, how many times?

If so, how many times?
A
B
C
D
E
F
G

Have you had any alternative treatment for the condition(s)?

Have you had any alternative treatment for the condition(s)?
A
B

If so, please write what you have tried below:

Did you find the alternative treatment(s) helpful?

Did you find the alternative treatment(s) helpful?
A
B

Where do/did you receive most of the information about your condition (s) from?

Where do/did you receive most of the information about your condition (s) from?

If other, please add further information below:

If you chose social media, which platform do/did you use most for information?

If you chose social media, which platform do/did you use most for information?

if other, please share information below:

Do you have any other medical conditions? please write further information below:

What has been the biggest impact from having the gynaecological condition(s)?

Do you have any mental health difficulties? please write further information below:

Has your condition affected your employment or education? if so, please share further information below:

Use 3 words to describe having the gynaecological condition(s)

Please can you tell me what outcome you would like to see from us making this documentary?

Have you seen a documentary on this subject matter before?

If there is anything I've missed or anything you'd like to share or add, please use the space below:

Name (you can remain anonymous)

Age