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Prevention Questionnaire

 

[ click for a printable version ]

Keep in mind that although most people associate bleeds with sports, bleeds can also be caused by other activities that involve some physical action or repetitive motion.

Print out this questionnaire, answer the following questions, and bring it to your next visit to a health care professional.

What activities cause you to worry that you might have a bleed?
________________________________________________________
________________________________________________________
________________________________________________________


What activities do you generally participate in, even though you know they might cause a bleed?
________________________________________________________
________________________________________________________
________________________________________________________


What activities do you avoid because you might have a bleed?
________________________________________________________
________________________________________________________
________________________________________________________


What activities could you enjoy more if you didn't have to worry about having a bleed?
________________________________________________________
________________________________________________________
________________________________________________________


Think of the bleeds you've had during the past year. Which of them might have been anticipated and avoided with a preventive infusion?
________________________________________________________
________________________________________________________
________________________________________________________

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The health information contained herein is provided for educational purposes only and is not meant to replace personal discussions between health care providers and patients. All decisions about patient care must be made with a health care provider who can assess the special needs of each individual patient.


   
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