Get Fairfax Colon & Rectal Surgery Constipation Questionnaire Form

Completing the Fairfax Colon & Rectal Surgery Constipation Questionnaire Form online is a straightforward process aimed at gathering important information about your bowel health. This guide will provide you with step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the questionnaire with ease.

1. Press the ‘Get Form’ button to obtain the questionnaire and open it in your document editor.
2. Begin by entering your name and the date at the top of the form. This ensures that your responses are appropriately attributed.
3. In the first section, you will answer how often you have passed a bowel movement in the past three months. Please check the option that best reflects your experience.
4. Next, indicate the usual consistency of your bowel movements by circling the type that applies to you in the provided options.
5. For the Constipation Scoring System section, respond to each question honestly regarding your bowel movement habits and related difficulties. Check the appropriate lines for each question and calculate your total constipation score at the bottom of the section.
6. In the following sections, select any techniques you may use to aid your bowel movements, describe how often you experience urges to go, and detail your history with medications that assist with bowel regularity.
7. If applicable, respond to the specific questions tailored for women regarding childbirth. If you identify as a man, proceed to the next relevant question.
8. Continue by checking any past surgeries related to your bowels or anus, and indicate if you currently have a stoma.
9. Complete the form by answering questions about any injuries, current medical conditions, emotional well-being, previous discussions about your constipation, and any referrals to other services.
10. Once you have completed all sections of the questionnaire, review your responses for accuracy. You can then save your changes, download the form for your records, print it if needed, or share it as directed.

Now that you have this guide, start completing the Fairfax Colon & Rectal Surgery Constipation Questionnaire Form online.