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Lung Health
Heart Health
Holistic Medical Care for Menopause (Integrative Medicine)
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Sports Well
Weight Management
Colorectal Cancer Screening Programme
Vaccines
Vaccination Services Introduction
CUHK Professors
Specialists and Professionals
Medical Packages
CUMC Medical Package
Integrated Medical Package
Price Transparency
Fees and Charges
Clinical Service Fee
Room Charge
General Hospital Service Charge
Price Transparency
Patient Info
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Data Access Request
Hospital Location
Insurance and Direct Billing
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Patient Support Programme
Request for Duplicate Medical Record
Room Facilities
Virtual Tour
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Flash News
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Irritable Bowel Syndrome (IBS) Assessment
Home
Irritable Bowel Syndrome (IBS) Assessment
Irritable Bowel Syndrome (IBS) Assessment
Your Name
*
Gender
*
Gender
Male
Female
Date of Birth
*
Telephone No.
*
Email
Height (m)
*
Weight (kg)
*
Please complete the below questionnaire
In the past 6 months, please select if you have any of the followings:
Abdominal pain
Abdominal pain once or above
I feel my pain get better after bowel movement
I feel my pain associated with a change in frequency of stool
I feel my pain associated with a change in form of stool
Diarrhea (1/4 time stool form is either loose or watery)
Abdominal discomfort
Abdominal distension
Feeling of incomplete evacuation
Urgency
Straining during defecation
None of the above
Do you have any other gastrointestinal diseases/symptoms?
*
Yes
No
If you answered "yes" for the above question, please write down your other gastrointestinal disease/symptoms
Have you done colonoscopy within the past five years?
Yes
No
I would like to receive gastrointestinal-related information from CUHK Medical Center
I am interested in participating health check or research organized by CUHK Medical Centre
I agree to provide my above information to CUHK Medical Centre for the use in research
I agree to be contacted by centre staff for preliminary consultation
Send
