SILLIMAN UNIVERSITY Name (optional): __________________________________ Age: _________ Put a check mark on the blanks that correspond your answers, or provide the necessary information. 1. Do you take oral contraceptives or birth control pills? ____ Yes ____ No If yes, please continue answering numbers 210. If no, please proceed to number 11-13. 2.
What classification of oral contraceptives do
you take? _____ Combined Oral Contraceptives _____ Progestin Only Contraceptive _____ Both _____ You dont know
3. Do you know that there are risks of taking the
pill? ______ Yes ______ No If no, please continue answering number 4. If yes, what do you think are these risks? (Please check as applicable) _____Increased risk of Cervical and Breast Cancer _____ Adverse effects on the physical aspect of the body. ____ Adverse effects on the emotional aspect of the body ____ Others, please specify, ___________________________________ 4. How long have you been taking oral contraceptives? _____ Less than one year _____ 1-2 years _____ 3-5 years
_____ More than five years
5. What are the reasons why you take the pill? (Please check as applicable) ______ Doctors prescription ______ Effective contraceptive ______ Normal menstruation ______ Healthy skin ______ Others, please specify, _________________________ 6. What do you think are the benefits you obtained from taking the pill? (Please check as applicable) _______ Effective contraceptive _______ Normal menstruation _______ Healthy skin _______ Others, please specify, ________________________ 7. After taking the pill, did you experience any negative physical effects on your body? ______ Yes _____ None If none, continue answering number 8 If yes, what are these negative effects? (Please check as applicable) _______ Dizziness _______ Nausea _______ Hypertension/ High Blood Pressure _______ Gall bladder stones _______ Difficulty in urinating _______ Others, please specify, ________________________ . 8. After taking the pill, are there any negative effects on your behavior and personality? ______ Yes ______ None If no, continue answering number 9 If yes, what are these? (Please check as applicable) ______ Mood swings
______ Loss of libido/ loss of sexual desires
______ High level of anxiety ______ Others, please specify, _________________________ 9. Do you believe that taking these pills would increase probability of having cancer? _______ Yes ______ No 10. If Proven that the taking the pill would increase the risk of having cancer, will you stop taking the pill? _______ Yes ______No
Only those who answered No in number 1 may
answer numbers 11-13 11. What are your reasons for not taking the pill? (Please check as applicable) ____ You are using other types of contraceptives ____ You know the risk of taking these pills ____ You think these pills are not effective ____ You do not need to use contraceptive ____ Others, please specify, ___________________________ 12. Do you think that taking these pills would increase probability of having cancer? ____ Yes ___ No 13. Do you have any plan taking these pills on the future? ____ Yes ___ No
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Summary: The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health by Robert F. Kennedy Jr: Key Takeaways, Summary & Analysis Included