Question Title

1. Name: (Required.)

Question Title

2. Please indicate the age range you fall into.

Question Title

3. Do you reside in the US?

Question Title

4. Which state do you reside in?

Question Title

5. Have you been diagnosed with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)? (Required.)

Question Title

6. When were you diagnosed? (month and year)

Question Title

7. Have you previously or currently been treated with avacopan (Tavneos®)? (Required.)

Question Title

8. If currently on avacopan, when did you start taking?

Question Title

9. What was your overall experience while taking avacopan?

Question Title

10. Would you be interested in further sharing your experience? Please select all that applies:

Question Title

11. If you are interested in sharing your story with the industry partner that makes Tavneos® (Amgen), do you give the VF permission to share your contact information?

Question Title

12. Contact Information:

T