1. How old are you?

  AGE
6-12
13-18
18-29
30-39
40-49
50-59
60-69
70+

2. Do you or a family member have Hemophilia?

3. How often do you, or your family member infuse independently?

4. When, if so, did you start infusing independently?

5. Do you/your family member use a syringe of saline before and after every injection?

6. How many times a week do you infuse more than one syringe-full of medication?

7. Do you experience trouble switching/maneuvering syringes by yourself when moving from one dose to the next at one time?

8. What are some workarounds when you/ your family member inject more than one syringe? (Tape to table, friend helping, etc.)

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