CLA PBC 2022

We also invite you to take this brief survey to help us to better serve you. Please share it with others you think may benefit.

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* 1. Do you participate in the Community Liver Alliance Support Group?

Yes

No

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* 2. Do you belong to another PBC support group?

Yes

No

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* 3. Please tell us the name of your group and location (City, State or Virtual)

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* 4. Which type of provider do you see for the management of your PBC: Primary Care doctor, GI specialist. Hepatologist, etc.?

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* 5. What would you like to learn more about PBC? What other kinds of resources do you need that are not currently available? Please share your needs below.

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* 6. What specific topics would you like to learn during the annual PBC Update?

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* 7. What gender specific or race specific health issues could we focus on?

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* 8. How has PBC affected you socially and economically?

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* 9. Are you a transplant patient or on a transplant list?

Yes

No

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* 10. We would like to reinstate the the quarterly support group and would like to know what day and time works best for you.

Days of the week:

Times of the day:

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* 11. We would like your mailing address so we can send program materials and occasional mailings.

Name

Caregiver Name

Address

City/Town

State/Province

Zip/Postal Code

Caregiver Email Address

Telephone Number