Hemophilia Treatment Survey
Please complete this survey to help us understand your hemophilia treatment experience. Your responses are confidential and will be used for research and improvement purposes.
Are you completing this survey as a:
*
Person living with hemophilia
Parent or caregiver
Other
What is your age group?
*
Please Select
Under 12 years
12–17 years
18–35 years
36–50 years
Over 50 years
What type of hemophilia do you (or the person you care for) have?
*
Hemophilia A
Hemophilia B
Other bleeding disorder
What is your current treatment regimen?
*
Prophylactic (regular, scheduled infusions)
On-demand (as needed)
Non-factor therapy
Other
How often do you (or the person you care for) experience bleeding episodes?
*
Please Select
Rarely (less than once a month)
Occasionally (1–3 times a month)
Frequently (more than 3 times a month)
Almost daily
How satisfied are you with your current hemophilia treatment?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
Please share any additional comments or suggestions about your hemophilia treatment experience.
Submit Survey
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