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Appendix B

Men's Health Questionnaire

Here are two examples of questionnaires you may like to use to assist in prompting discussion on health issues with your male patients.

Decide which one you feel more comfortable with.

Arrange for Reception staff to hand the Questionnaire to men when they present for an appointment. It is important to make sure that patients have not recently completed the form. You may wish to ask your Receptionist to give the form to men with a comment along the lines of "If you haven't completed one of these Questionnaires in the last six months, or if something has changed in the way that you look after your health, you might like to fill this in before you see the doctor. Just give it to him/her when you go in."

You can use the patient's responses to guide your discussion on Health Promotion issues during the consultation

Don't assume that because a male patient has not completed the form, he does not have risk factors or health promotion issues which he would like to discuss.

You may wish to retain the patient's completed questionnaire in the medical record.

You may also wish to enter some or all of the data on the patient's electronic record.

Patients who complete the Questionnaire on more than one occasion (eg. every 6-12 months) may be interested to see changes in their risk factors over time

North East Valley Division General Practice, Victoria, Australia, Disclaimer 
Level 1, Pathology Building, Repatriation Campus, A&RMC, Heidelberg West VIC 3081. .. map
Phone: 03 9496 4333, Fax: 03 9496 4349,  Email: nevdgp@nevdgp.org.au
Please note: NEVDGP does not provide an on-line consultation

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