Please answer the 37 questions of the health survey completely, honestly, and without interruptions with regards to your (or your child’s) health is now compared to how it was before she/he/you had surgery for the pilonidal condition.
Please note that this survey must be completed on a computer. It doesn’t work on a cellphone. When you are done, click the button to “Print Completed Form” and save it as a PDF on your desktop. Then simply email the completed form with your name to firstname.lastname@example.org.
Do not refresh your browser webpage or you will lose your input data. Your information is not captured or stored by The Sternberg Clinic.
When you have completed this survey, click “Print this Page” above. Send your completed form, along with your Patient ID Number, to email@example.com
Do not refresh your browser webpage or you will lose your input data.