| Check the activities that are most important to you | Specify the activity (e.g., gardening) | How would this activity be affected by ostomy? | How would this activity be affected by sphincter-spring surgery? |
| [ ] Activities I do by myself | |||
| [ ] Interactions with family and friends | |||
| [ ] Recreation/sports | |||
| [ ] Religious activities | |||
| [ ] Volunteering/community service | |||
| [ ] Work | |||
| [ ] Sex and intimacy |
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