Genetic Blood Disorders Survey Form
Please complete this survey to share information relevant to genetic blood disorders. Your responses will help us better understand experiences and perspectives related to these conditions.
How old are you?
*
What is your gender?
*
Female
Male
Non-binary
Prefer not to say
Do you have a diagnosed genetic blood disorder?
*
Yes
No
Unsure
Which of the following genetic blood disorders have you or a close family member been diagnosed with? (Select all that apply)
*
Sickle cell disease
Thalassemia
Hemophilia
Von Willebrand disease
None
Other
Have you experienced any of the following symptoms? (Select all that apply)
Frequent fatigue
Easy bruising or bleeding
Pain crises
Delayed growth
None of the above
How would you rate your awareness of genetic blood disorders?
*
1
2
3
4
5
How much do genetic blood disorders affect your daily life?
*
Not at all
1
2
3
4
Significantly
5
1 is Not at all, 5 is Significantly
Please indicate how much you agree with each statement below:
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel informed about my condition.
1
2
3
4
5
I have access to resources and support.
6
7
8
9
10
I am comfortable discussing my condition with others.
11
12
13
14
15
What resources or support would you find most helpful?
Is there anything else you would like to share about your experience with genetic blood disorders?
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