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About You

This Survey has been created to help the Society gather information for use when campaigning and for research purposes.

Please take the time to fill in as much as you can as this gives the Society powerful statistics to work with.

The last section asks if you would mind being contacted about taking part in research in relation to improving the detection and treatment of B12 deficiency and Pernicious Anaemia.

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* 1. Are you?

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* 2. What is your Date of Birth?

Date

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* 3. Have you been diagnosed as being deficient in Vitamin B12?

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* 4. If so when was this diagnosis?

Date

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* 5. What was your B12 level when it was detected?

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* 6. Have you been formally diagnosed with Pernicious Anaemia?

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* 7. How old were you when you were diagnosed with Pernicious Anaemia?

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* 8. For how long had you experienced symptoms before being diagnosed?

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* 9. Please specify your ethnic origin:

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* 10. Are you?

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* 11. Did or do any of the following relatives have Pernicious Anaemia?

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* 12. What colour are your eyes?

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* 13. What colour is your hair?

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* 14. If Grey, at what age did your hair turn grey?

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