Testicular Self-Exam Awareness Survey
Help us understand awareness and practices related to testicular self-examination. Your responses are confidential and will be used to improve health education.
Your Age Group
*
Please Select
Under 18
18-24
25-34
35-44
45 or older
Gender
*
Male
Female
Prefer not to say
Other
How familiar are you with testicular self-exams?
*
Not at all familiar
1
2
3
4
Very familiar
5
1 is Not at all familiar, 5 is Very familiar
Have you ever heard about testicular self-exams before this survey?
*
Yes
No
How often do you perform testicular self-exams?
*
Monthly
Every few months
Rarely
Never
What are the main reasons you do not perform testicular self-exams regularly? (Select all that apply)
Not sure how to do it
Forget to do it
Don’t think it’s necessary
Feel uncomfortable
Other
Where did you first learn about testicular self-exams?
*
Healthcare provider
School/education
Internet/social media
Family/friends
I have not learned about it
Other
Please rate your confidence in performing a testicular self-exam correctly.
*
1
2
3
4
5
What would encourage you to perform testicular self-exams more regularly? (Select all that apply)
More information on how to do it
Reminders
Hearing about risks/benefits
Support from healthcare provider
Other
Please indicate your agreement with the following statements about testicular self-exams.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Testicular self-exams are important for early detection of health issues.
1
2
3
4
5
I feel comfortable discussing testicular health with a doctor.
6
7
8
9
10
I would like to receive educational materials about self-exams.
11
12
13
14
15
Would you like to receive more information about testicular self-exams?
*
Yes
No
If you answered 'Yes' above, please provide your email address (optional):
example@example.com
If you have any additional comments or questions, please share them below:
Submit Survey
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