Immunoglobulin Therapy Experience Survey
Share your experience with immunoglobulin therapy to help us improve patient care.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
How long have you been receiving immunoglobulin therapy?
*
Please Select
Less than 6 months
6-12 months
1-2 years
More than 2 years
What is your method of immunoglobulin administration?
*
Intravenous (IVIG)
Subcutaneous (SCIG)
Other
Please rate your experience with the following aspects of your therapy.
*
Rows
Very Poor
Poor
Average
Good
Excellent
Ease of administration
1
2
3
4
5
Effectiveness of treatment
6
7
8
9
10
Support from healthcare team
11
12
13
14
15
Convenience of therapy schedule
16
17
18
19
20
Have you experienced any side effects from immunoglobulin therapy?
*
Yes
No
If yes, please select the side effects you have experienced.
Headache
Fatigue
Fever/Chills
Nausea/Vomiting
Allergic reactions
Other
Overall, how satisfied are you with your immunoglobulin therapy?
*
1
2
3
4
5
Please share any additional comments or suggestions about your therapy experience.
Submit Survey
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