Teen Insight Mental Health Survey #1

This survey will cover mental health. What is mental health? Quite simply, mental health refers to the well-being of your thoughts, emotions, and behavior.

Remember, your answers can only be viewed by ASF staff and anything with your name will not be shared with your parents or anyone else without your direct, written consent. This survey should only take approximately XXXX minutes of your time.

1.Please type your first and last name.

2.Do you feel Alport syndrome affects your mental health?

Yes

I'm not sure

3.Have you ever felt alone in your Alport experience?

Yes

4.Please select the people you most speak to regarding your Alport syndrome experiences. Select all that apply.

Parents

Friends (non-Alport patients)

Other Alport patients

Siblings (diagnosed with Alport syndrome)

Siblings (not diagnosed with Alport syndrome)

My nephrologist

My teachers

My athletic coaches

Therapist

Other (please specify)

5.Do you feel you can speak openly with your family members about your Alport syndrome experiences?

Yes

6.If you have siblings (diagnosed with Alport syndrome or not), do you discuss your Alport concerns with them more or less than you do with your parents?

I do not have siblings

I discuss Alport syndrome with my siblings more than with my parents

I discuss Alport syndrome with my parents more than with my siblings

Would you like to explain your choice of who you talk more about Alport syndrome with?

7.Do you feel as if your non-Alport patient friends understand the challenges someone with Alport syndrome faces on a daily basis?

Yes

I'm unsure

Comments?

8.Have you ever not taken your important Alport-related medications because you were having "a bad day"?

Yes

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