Informed Consent Survey
ONLY TAKE THIS SURVEY IF YOU HAVE HAD ABDOMINAL OR PELVIC SURGERY. Vote once for for each time you have had a separate procedure (limit 5). Check all boxes that apply. To record when/where and type of procedure, click submit -- follow the links.

1. YES, I have had abdominal or pelvic surgery
2. No I have NOT had abdominal or pelvic surgery
3. I knew beforehand that the procedure would include cutting (lysis) of adhesions
4. I am male
5. I am female
6. Prior to surgery I was provided with information about the risks of adhesions
7. Prior to surgery I was provided information about the risks of adhesions as part of the informed consent (consent to surgery)
8. Prior to surgery I was provided written information about adhesions
9. Prior to surgery I was told the information about adhesions
10. Prior to surgery I was shown a movie/ video which included information about adhesions
11. Prior to surgery I was told that adhesion barriers might be used
12. Prior to surgery I was told that adhesion barriers would not be used
13. Prior to surgery I was told nothing about adhesion barriers
14. This procedure was performed in the USA (please provide year and state)
15. This procedure was performed in Canada (please provide year and province)
16. This procedure was performed in Europe (please provide year and country)
17. This procedure was performed in another country (please provide year and country)
18. I consent to the use of this information and understand that individual information will not be published, but masked or aggregated with other information