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. 2017 Jan-Feb;11(1-2Suppl1):S88–S91. doi: 10.5489/cuaj.4338
1) Are you a full-time pediatric urologist?
Yes ❏ No ❏

2) Which province and city do you practice in?
Province___________________  City___________________

3) What year did you begin practicing?
Year______________

4) Do you have a transition process for SB patients from adolescence to adulthood in place in your centre?
Yes ❏ No ❏

5) Do you personally provide the ongoing urological care for SB patients after their transition from pediatric care?
Yes ❏ No ❏

6) Do you have an identified recipient adult or transitional urologist in your community to care for adult SB patients?
Yes ❏ No ❏

7) Is sexual function formally discussed with your male and female SB patients as part of transition?
Yes ❏ No ❏

8) Is pregnancy, as well as birth control, discussed with female SB patients as part of transition?
Yes ❏ No ❏

9) Do you feel transition adult clinics should be the norm and parallel the pediatric multidisciplinary clinics (as opposed to having a single-specialty provider)?

10) Do you utilize a questionnaire or a checklist to determine transition readiness of patients?
Yes ❏ No ❏

11) At what age should the transition process begin, in general, for SB patients?
Age _____________

12) If you are a pediatric urologist, do you encourage patients to attend appointments independent of their parents as they grow older?
Yes ❏ No ❏

13) If you answered ‘yes’ to question 12, at what age do you encourage patients to attend appointments independent of their parents?
Age _____________

14) What are other diagnoses besides SB where transition might be contemplated for ideal urological care?