Questionnaires

Uterine Fibroid Study (UFS)

For more information about the Uterine Fibroid Study questionnaires, contact Donna D. Baird, Ph.D.

Baseline Questionnaires

• Mail Questionnaire (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_base_mail.pdf)   (493K)
• Telephone Questionnaire (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_base_phone.pdf)   (425K)
• Dietary Questionnaire (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_diet.pdf)   (389K)
• Daily Diary (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_diary.pdf)   (71K)

Medical Records & Forms

Sonography Forms

• Study (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_study_son.pdf)   (56K)
• Medical Record (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_medrec_son.pdf)   (23K)
• Blood Collection Form (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_blood.pdf)   (24K)

Pathology Forms

• Uterus and Fibroids (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_path.pdf)   (114K)
• Fibroid Tissue H&E (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_he.pdf)   (43K)

Abstraction of Surgical Medical Records

• Surgery (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_medrec_surgery.pdf)   (24K)
• Random Sample (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_medrec_random.pdf)   (69K)

Follow-up Study Questionnaires

• Interview 1 (August 2001) (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_fu1_2001.pdf)   (540K)
• Interview 3 (October 2001) (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_fu3_2001.pdf)   (504K)
• Medical Record Sonography (2001) (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_fu_son_2001.pdf)   (34K)
• Mini-Questionnaire (2004) (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_fu_mini_2004.pdf)   (37K)
• Perceived Racism (http://www.niehs.nih.gov/research/atniehs/labs/epi/studies/ufs/docs/ufs_racism.pdf)   (173K)

 Back to top