Please answer the 37 questions of the health survey completely, honestly, and without interruptions with regards to how your (or your child’s) pilonidal condition is affecting you or them.
Please complete this on a desktop computer. It is not formatted for a mobile device. Do not refresh your browser webpage or you will lose your input data. Your information is not captured or stored by The Sternberg Clinic.
Choose one option for each questionnaire item. When you are done, click the button to “Print Completed Form” and save as a PDF or print on paper. Please complete prior to your day of surgery.
Member of ASCRS, Crohn’s & Colitis Foundation, American College of Surgeons, and Pilonidal Support Alliance