JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Menstrual Hygiene Campaign - Everybody's Business
Personal Details
We do not sell or share your details with anyone but we will use your data for internal analysis.
* Indicates required question
Your First name
*
Your answer
Your Last Name
*
Your answer
Email
*
Your answer
Phone number (WhatsApp)
*
Your answer
Age
*
Your answer
Who do you live with?
Your answer
State of Residence
*
Your answer
Country of Resident
*
Your answer
Your Tribe:
*
Your answer
Explain how menstruation is regarded in your tribe :
*
Your answer
Menstruation Details
Tell us about your menstruation
At what age did you start menstruating?
*
Your answer
Were you taught about menstruation before it started?:
*
Yes
No
Do you experience menstrual cramps/pains?
*
Yes
No
How does your period affect your daily activities?:
*
Your answer
Do you experience menstrual cramps/pains?
*
Yes
No
Sanitary Pad Details
Provide information about the usage of your sanitary pad
What sanitary pad brand/product do you use?
*
Your answer
How much is a sanitary pad(s) in your area?
*
Your answer
How many pads do you consume per period?
*
Your answer
How long do you wear each pad in a day before changing?
*
Your answer
Do you experience any effect or changes in your private region as a result of the pad usage?
*
Yes
No
How do you dispose your pads?
*
Your answer
During your menstruation, what are the menstrual hygiene practices you carry out?
*
Your answer
What is your assessment on the quality of these pads you use?
*
Your answer
Is there anything you would suggest to improve upon it to make it better, more convenient and comfortable?
*
Your answer
Can you educate a woman or a girl in the rural areas, villages or orphanage homes who have little or no education on menstrual hygiene practices?
*
Yes I can
No I can't
Yes but I don't have the time
Yes but I don't know how to
Have you ever been embarrassed publicly by your period?
*
Yes
No
If Yes, was there a nearby emergency changing room where you could clean up before getting home?
Yes
No
Clear selection
Can you save a girl from the health risks associated with poor menstrual hygiene by donating a sanitary pad monthly to her?
*
Yes
No
Join our community on WhatsApp: +2347039248344
Follow and Like us on Facebook :
https://www.facebook.com/refoundation.org/
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms