Hernia Screening Questionnaire

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Home ▸ Hernia Screening Questionnaire

Hernia Screening QuestionnaireSt. Elizabeth Website Coordinator2025-06-27T16:37:45-04:00

Hernia Screening Questionnaire

Welcome to St. Elizabeth's hernia screening questionnaire. We're here to help you take the first step toward understanding your health. This quick and easy quiz is designed to give you valuable insights and guide you toward the best care options available. By answering a few simple questions, you can gain a clearer picture of your symptoms and take proactive steps toward your well-being. Ready to get started? Take the quiz now and embark on your journey to better health.

Do you notice a bulge in the groin?(Required)

Yes

Does the bulge get larger/become more noticeable later in the day?(Required)

Yes

Do you have pain in the groin area?(Required)

Yes

Does activity or being on your feet make the pain/soreness worse?(Required)

Yes

Do you ever feel or hear gurgling in the groin?(Required)

Yes

Do you notice a bulge or "outtie" at the belly button?(Required)

Yes

Does the bulge get larger/become more noticeable later in the day?(Required)

Yes

Do you have pain in the belly button area?(Required)

Yes

Does activity or being on your feet make the pain/soreness worse?(Required)

Yes

Do you ever feel or hear gurgling in the belly button?(Required)

Yes

Have you had prior abdominal surgery?(Required)

Yes

Do you notice a bulge at any of the scars from your prior incisions?(Required)

Yes

Do you have any pain at the scars from your prior incisions?(Required)

Yes

Does activity, lifting, or being on your feet make the pain/soreness worse?(Required)

Yes

Do you ever feel or hear gurgling at the scars from your prior incisions?(Required)

Yes

Do you have chronic constipation or have to strain to move your bowels or empty your bladder?(Required)

Yes

Do you have a chronic or recurrent cough?(Required)

Yes

Name(Required)

First Last

Primary Language

Phone(Required)

Zip or Postal Code(Required)

Your Email Address(Required)

Preferred Contact Time(Required)

Preferred Provider

Preferred Location

Consent(Required)

By using this website and submitting this form, I agree to the terms of the privacy policy and terms of use. I consent to receive follow up communication from St. Elizabeth Healthcare by phone and email related to this service.(Required)

You May Not Be A Good Candidate

Based on your responses, it appears that you may not need a hernia evaluation at this time. However, if you have any concerns about your health, we encourage you to schedule an appointment with your primary care physician to discuss your symptoms and options. Your well-being is our priority, and we're here to support you in any way we can.

You May Be A Good Candidate

Based on your responses, you may be a candidate for a hernia evaluation. We recommend scheduling an appointment with one of our specialists to discuss your symptoms and explore the best treatment options for you. Early diagnosis and treatment can make a significant difference in your recovery. We're here to provide the personalized care and support you need.

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