Thank you for taking part in this quick survey to help us better understand how you treat your vaginal dryness. This will help us to provide better information required to support women like you. 

By completing this survey,
you will be mailed a $10 coffee gift card.

Thank you again for your help!
start
 
What is your age? *


 
Would you describe yourself as: *


 
What are your menopausal related symptoms? (select all that apply) *


 
What is your one most bothersome symptom? (select only one) *


 
What vaginal health products are you familiar with or aware of? (select all that apply) *


 
What is the reason(s) why you are having vaginal symptoms? (select all that apply) *


 
What sources of information do you use to better understand your medical condition or diagnosis? (select all that apply) *


 
How did you find this website, RepaGyn.ca?


 
How many months after your first vaginal symptom did it take for you to talk to a healthcare professional or seek treatment? (please enter a numeral)

 
Have you discussed your vaginal symptoms with the following healthcare professionals? (select all that apply)


 
Why have you not discussed this with a healthcare professional? (select all that apply)


 
If you had discussions with a healthcare professional, what was the primary treatment recommended for your vaginal symptoms? (select only one)


 
How long did your doctor tell you that you will need to take this product for?


 
Have you tried a product for these vaginal symptoms without a healthcare provider’s recommendation?

     
 
Which product(s) have you tried? (select all that apply)


 
What is your current primary product to treat vaginal symptoms? (select only one)


 
For how many months have you been taking this product?

 
What is your level of satisfaction with this product to treat your vaginal symptoms?


 
Would taking a hormone therapy concern you?

     
 
Why or why not?

 
Are you aware that healing the vaginal lining (restoring the cell lining by healing tears and damage) is an important aspect of treating vaginal dryness?

     
 
Would having to talk to a pharmacist to get a product for this condition (because it is behind the pharmacy counter) versus just getting it off the front store shelf discourage you from trying a product?


 
Why or why not?

 
If you were recommended RepaGyn, and not taking it, why not?

 
What is your level of satisfaction with RepaGyn?


 
How long did your doctor tell you that you will need to take RepaGyn for?


 
Did you have any problems obtaining RepaGyn?


 
Anything else you would like to add regarding RepaGyn, the website, patient information, or other suggestions?

 
You're all done! Please provide your name and address to receive your $10 Tim Horton’s gift card in the mail.

 
Full Name

 
My mailing address is:

 
I consent to being contacted by BioSyent in the future to complete surveys or questionnaires

     
Thanks again for your help!

By completing this survey you are consenting to the collection and use of this information by BioSyent Pharma Inc.

If you have any questions about this program, or would like to remove your email address from our database, please call 1.866.436.0013.  All information will be strictly confidential and summarized into aggregate data only.  Please review our privacy policy.
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