1.What is your professional role?(Required.)

Physician - Haematologist

Nurse

Physiotherapist

Psychologist

Social worker

Physician - Other specialty OR Other healthcare professional (please specify)

2.Please provide your email

3.Age category(Required.)

18-24

25-34

35-44

45-54

55-64

65+

Prefer not to say

4.What is your gender?(Required.)

Female

Male

Other (specify)

5.Which is your country of residence?(Required.)

AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte D'IvoreCroatiaCubaCyprusCzech RepublicDemocratic People's Republic of KoreaDemocratic Republic of CongoDenmarkDjiboutiDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia (Federated States of)MonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaState of PalestineSudanSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandThe former Yugoslav Republic of MacedoniaTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited Republic of TanzaniaUnited States of AmericaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)VietnamYemenZambiaZimbabwe

6.Years of experience in haemophilia care(Required.)

Less than 1 year

1 -5 years

6-10 years

11-15 years

16 - 20 years

More than 20 years

7.Practice setting(Required.)

Involved in clinical trials

University/academic hospital

Non-academic hospital

Private practice

Other (please specify)