1.What is your current age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

2.What gender do you identify as?

Man

Woman

Non-binary or other

Prefer not to share

3.Which best describes the area where you live?

Rural

Urban

Suburban

4.Race/Ethnicity (select all that apply)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity (please specify)

5.Which of the following best describes your use of medication to manage your Narcolepsy Type 1?

I currently take prescription medication to manage Narcolepsy

I took prescription medication in the past to manage Narcolepsy, but no longer take any prescription medication

6.When were you diagnosed with Narcolepsy Type 1?

Within the past 3 years

4 - 10 years ago

11 - 15 years ago

More than 15 years ago

7.Health insurance type:

Group coverage through my employer or the employer of a family member

Health insurance exchange, enrolled through Affordable Care Act

Medicaid

Medicare

Other / not sure

Private insurance, purchased directly from an insurance company

8.Is there anything you’d like to share about your financial or social circumstances that have shaped your patient and treatment journey?

9.Are there other chronic conditions that you manage alongside Narcolepsy Type 1? Please list those diagnoses here.

10.In 2-3 sentences, do you want to share anything else you feel we should know about you?

11.First Name:

12.Email Address:

13.State: