Section 1: General and zygosity question
1. What type of twin are you ?
Identical
Non-Identical
2. How old are you (year)?
3. To which race do you belong to?
Malay
Chinese
Indian
Others
4. Who is filling up this questionnaire?
Twin themselves
Parents
Sibling
Relatives
5. Were the twins living with each other during childhood?
Yes
No
6. Are the twins’ look like two peas in a pot?
Yes
No
Don't Know
7. Did relatives, siblings and friends have difficulty recognizing twins?
Yes
No
Don't Know
8. Were twins wearing identification marks during childhood?
Yes
No
Don't Know
Section 2: Contact Information
Twin 1
Twin 2
Name:*
IC Number:*
Postal Address:*
Home Tel:*
Hand phone:*
E-mail:*
Name:*
IC Number:*
Postal Address:*
Home Tel:*
Hand phone:*
E-mail:*
Section 3: Socio-demographic and reproductive health questions:
No.
Description
Twin 1
Twin 2
1.
Gender:*
2.
Education:*
3.
Occupation:*
4.
Marriage status:*
5.
Birth Weight (grams):*
6.
Gestational age:*
7.
Breast fed:*
Yes
No
Yes
No
8.
Blood Group: *
A
B
AB
O
9
A
B
AB
O
9
9.
RH:*
Negative
Positive
Negative
Positive
10.
Congenital abnormality:*
Yes
No
Yes
No
11.
Vaccination:*
Yes
No
Yes
No
12.
Age of menarche:
13.
Menstruation:
Yes
No
Yes
No
14.
Duration (days):
15.
Interval (days):
16.
Amount:
Low
Normal
High
Low
Normal
High
17.
PMS:
Yes
No
Yes
No
18.
Age of Marriage:*
19.
Age of First Pregnancy:
20.
G:
P:
Ab:
Ch:
Boy:
Girl:
G:
P:
Ab:
Ch:
Boy:
Girl:
21.
Last Delivery:
Normal
C/S
AS
Normal
C/S
AS
22.
Prenatal Care:
Hospital
Clinic
Private
None
Hospital
Clinic
Private
None
23.
Postnatal Care:
Hospital
Clinic
Private
Home
None
Hospital
Clinic
Private
Home
None
24.
Brest Feeding:
Yes
No
Yes
No
25.
Gynecological problem:
Yes
No
Yes
No
26.
Irregular menstruation:
Yes
No
Yes
No
27.
Amenorrhea:
Yes
No
Yes
No
28.
Acne:*
Yes
No
Yes
No
29.
Hirsutism:*
Yes
No
Yes
No
30.
Baldness:*
Yes
No
Yes
No
31.
Weight / Height:
/
/
32.
Infertility:*
Yes
No
Yes
No
33.
Family planning:
Yes
No
Yes
No
34.
Cancer:*
Yes
No
Yes
No
35.
Pap smear:
Yes
No
Yes
No
36.
Age of menopause:
37.
Hot flushes:*
Yes
No
Yes
No
38.
Sweating:*
Yes
No
Yes
No
39.
Pain in bones and joints:*
Yes
No
Yes
No
40.
Depression:*
Yes
No
Yes
No
41.
Irritability:*
Yes
No
Yes
No
42.
Low libido:*
Yes
No
Yes
No
43.
Dysparonia:
Yes
No
Yes
No
44.
Erectile dysfunction:**
Yes
No
Yes
No
45.
Premature ejaculation:**
Yes
No
Yes
No