Submission Time

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1. Name of State

2. Select LGA

3. Name of Ward:

5. Agency

8. Please Enter Date of Survey

10. Is the respondent a health provider or a caregiver?

11. Please indicate your profession

12. Please indicate your age (Yrs) as at your last birthday

13. Please indicate your highest level of education

14. Please indicate your current employment status

15. Please indicate the type of your current place of residence

16. Please indicate your marital status

17. Have you ever heard about HPV?

19. HPV is the most common sexually transmitted disease

20. HPV is a serious health problem

23. Do you agree that cervical cancer tops among Nigerian women?