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Surveys
2013
November
O
OMFS oralcancer
OMFS oralcancer
0%
Exit Survey
P/C (Presenting Complaint):
Specify
-- Select --
1
2
3
Intra-Oral
-- Select --
1
2
3
Extra-Oral
-- Select --
1
2
3
H/P/C (History Of Presenting Complaint)
Days(s)
-- Select --
1
2
3
4
Week(s)
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1
2
3
4
Month(s)
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1
2
3
4
Year(s)
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1
2
3
4
H/P/C (History Of Presenting Complaint)
Days(s)
-- Select --
1
2
3
4
Week(s)
-- Select --
1
2
3
4
Month(s)
-- Select --
1
2
3
4
Year(s)
-- Select --
1
2
3
4
Any previous Medical History?
Yes
No
If you answered "Yes" to the above Question.
Please specify.
Diagnosis
Since
Medications used
Medications still being used
CVS
ENDO
RESP
GIT
GUT
NEURO
Other
If you answered "Yes" to both of the above questions
How Efficient were you in getting your Previous Medical Condition Treated?
Immediately
Weekly
Monthly
Quarterly
Annually
Other
How much time has elapsed since your "Oral Pathology" was initially detected
Day(s)
-- Select --
1
2
3
4
Week(s)
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1
2
3
4
Month(s)
-- Select --
1
2
3
4
Year(s)
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1
2
3
4
The Pathology was initially "noticed by" :
Myself
-- Select --
1
2
3
4
My Family
-- Select --
1
2
3
4
My Physician
-- Select --
1
2
3
4
Other
-- Select --
1
2
3
4
The Pathology was initially "noticed as" :
Pain
Swelling
Ulcer (persistent /non-persistent)
Hardness (induration)
Discoloration
Difficulty in swallowing
Difficutly in chewing
Difficulty in mouth opening
Discharge
Other
Primary step taken after noticing the pathology:
Consulted my doctor
Home Remedies
I thought it would heal on its own
No response
Other
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