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Rx Bandz Patient Survey
1.
Do you or an immediate family member own an auto-injector (for example, an EpiPen for allergies), etc.?
Yes
No
2.
Have you ever used an auto-injector (for example, an EpiPen) for allergies. Please consider use for both emergency and practice situations. (Select all that apply)
Yes, I have used on myself
Yes, I have used on someone else
No, I have never used one
3.
How frequently or infrequently do you carry your auto-inject with you when you are ‘on the go’ (as opposed to being home)? (Select one)
Always
Frequently
Sometimes
Rarely
Never
4.
IF ANSWERED "Always" IN Q3, SKIP THIS QUESTION. What are the main reasons that you don’t carry the auto-injector with you at all times? (Type in response)
5.
Please share your experiences carrying an auto-injector. What do you like and what do you wish you could change?
6.
What features in an auto-injector are most important to you?
7.
Is there anything else you would like to share?
8.
Would like to join our mailing list to receive the latest news about our auto-injector? If so, then please provide your email below.
Thank you for your time! We truly value your input.
Name
Email Address
Current Progress,
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