.

Dear Sir or Madam,please consider taking about 10 minutes to answer this questionnaire.

Secured
Survio
Create a survey


You reply as :

Please note that if you are responding as a caregiver, complete this questionnaire with the patient's answers.

How did you find out about your amyloidosis?

Select one answer

At what age did you develop the first symptoms of amyloidosis?

Select one answer

For which symptom(s) did you initially consult your doctor?

Choose all that apply

At the time of your first consultation, would you say that your symptoms were :

Select one answer

At the time of your first consultation, would you say that the symptoms were :

Select one answer

Prior to your diagnosis, had you been admitted to hospital because of symptoms related to your amyloidosis?

Select one answer

Between the first symptoms and the diagnosis, how many doctors did you consult?

Before diagnosis, which health professionals did you consult?

Choose all that apply


Before diagnosis, what tests were conducted ?

Choose all that apply

Over what period of time were tests conducted?

Select one answer

Which doctor first suspected that you had amyloidosis?

Select one answer

Which doctor first confirmed the diagnosis of amyloidosis?

Choose all that apply

Were you given an information document about amyloidosis at the time of diagnosis?

Select one answer

How long did it take between your first symptoms and the diagnosis?

Select one answer

Did any new symptoms appear between your first consultation and your diagnosis?

Select one answer

Between onset of symptoms and diagnosis have your symptoms change?

Note 0 if your symptoms have not changed, 1 to 5 if they have worsened, -1 to -5 if they have regressed.
0
Regressed
Worsened


Before diagnosis, had you ever heard of amyloidosis?

Select one answer

How did you feel when you were diagnosed?

Choose all that apply

Where are the medications specific to your amyloidosis administered:

Select one answer

Following your diagnosis, how quickly did you start your treatment ?

Select one answer

What symptoms are you suffering from today?

Select one answer in each row if you suffer from that symptom

How would you rate your current state of physical health?

Rate from 1 star for a very bad condition to 10 stars for an excellent condition

How would you rate your current morale today?

Rate from 1 star for a very bad condition to 10 stars for an excellent condition


How did you learn about this study?

Select one answer

Gender of the patient

Select one answer

Age of the patient

Select one answer

Type of amyloidosis :

Select one answer

Country of residence

Select in the list

Annual net household income :

Select one answer

Annual net household income :

Select one answer

Annual net household income :

Select one answer

Annual net household income :

Select one answer

Annual net household income :

Select one answer

Annual net household income :

Select one answer

Do you live outside a capital city?

Select one answer

Annual net household income :

Select one answer

Annual net household income :

Select one answer

Annual net household income :

Select one answer

Annual net household income :

Select one answer
Thank you for your time and your feedback.

As part of the AMYlife study, we value your participation and the insights you've provided. If you feel comfortable and would like to contribute further, we invite you to share more about your journey with amyloidosis. Your story can help raise awareness, foster understanding, and provide support to others facing similar challenges. You can express your wish to be contacted by writing to the following address : amylifestudy@gmail.com


Cliquez ici