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Family Member Questionnaire – SHQ 2 U

This questionnaire is designed to gather valuable feedback from family members of individuals with disabilities to help shape an in-home cervical screening service. The goal of this project is to ensure that people with disabilities have access to cervical screening in the comfort and privacy of their own homes, with the support of trained SHQ nurses.

We value your perspective as a family member because you play a key role in the well-being of your family member you care for. Your input will help us better understand the specific needs, concerns, and preferences of people with disabilities when it comes to cervical screening.

This form can also be downloaded as a pdf to complete offline, and returned to our Disability Team in person or emailed to [email protected].

 


 

"*" indicates required fields

Name * Required
Enables you to receive a copy of your responses.
1. How familiar are you with cervical screening and its importance for people with disabilities? * Required
2. Have you been involved in helping the person you care for access cervical screening in the past? * Required
3. How do you feel about the idea of having a health care provider come to your home to conduct the cervical screening? * Required
4. What would make you feel comfortable with a health care provider coming to your home for cervical screening? (You can tick more than one) * Required