Multiple Myeloma

Please answer the questions below truthfully and completely, thank you. Feel free to access your my chart or look up anything that is not known.

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* 1. Do you experience bone pain in the chest or spine?

Yes

No

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* 2. Do you experience persistent nausea and decreased appetite?

Yes

No

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* 3. Do you experience persistent constipation?

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* 4. Have you had persistent weight loss?

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* 5. Do you experience persistent weakness in the legs?

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* 6. Is there a family history of multiple myeloma?

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* 7. Do you have monoclonal gammopathy of undetermined significance?

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* 8. Do you experience frequent infections?

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* 9. Are you greater than 18 years old?

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* 10. Have you been diagnosed with multiple myeloma?

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* 11. Are you currently pregnant?

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* 12. Are you free of viral or bacterial infections (current)

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* 13. Has your blood work shown Serum Protein > 0.5 g/dL?

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* 14. Has your lab work shown a urinary protein excretion greater than 200 mg for 24 hours?

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* 15. Would you like to be contacted and paid if your survey answers match a study?

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