SurveyMonkey Powered Online Survey

Batten-1 Phase 3 Clinical Trial Interest

We are interested in gathering information to help inform clinical trial recruitment. Your feedback is greatly appreciated. Please note that all responses to this survey are anonymous.

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* 1. Patient Information:

Age:

Gender:

Date of Diagnosis:

City of Residence:

State of Residence:

Country of Residence:

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* 2. Additional Patient Information (If more than 1):

Age:

Gender:

Date of Diagnosis:

City of Residence:

State of Residence:

Country of Residence:

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* 3. On-site assessments will be conducted every 6 months. Are you (patient and caregiver) willing to participate in the on-site visits ?

Yes

If "No," why not?

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* 4. Some site visits may require an overnight stay (or 2 in the case of travel). Are overnight stays acceptable?

Yes

If "No," why not?

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* 5. Travel expenses will be covered by the sponsor. How far are you willing to travel to participate in on-site visits?

Less than 2 hours

Between 2 & 6 hours

Over 6 hours, but within same day

Overnight travel

In case of limits, what would be the main reason (patient too weak/tired, lack of availability of caregiver, other)?

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* 6. What forms of transportation are acceptable?

Car

Train

Plane

Other Comments

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* 7. Are you willing to travel to a different country?

Yes

If "No," why not?

Batten-1 Phase 3 Clinical Trial Interest

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* 1. Patient Information:

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* 2. Additional Patient Information (If more than 1):

Question Title

* 3. On-site assessments will be conducted every 6 months. Are you (patient and caregiver) willing to participate in the on-site visits ?

Question Title

* 4. Some site visits may require an overnight stay (or 2 in the case of travel). Are overnight stays acceptable?

Question Title

* 5. Travel expenses will be covered by the sponsor. How far are you willing to travel to participate in on-site visits?

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* 6. What forms of transportation are acceptable?

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* 7. Are you willing to travel to a different country?

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* 8. Additional Comments: