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* 1. What is your connection to epilepsy?

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* 2. How long since you were (or your loved one was) diagnosed with epilepsy?

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* 3. After being diagnosed, how long did it take to share your story?

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* 4. How do you identify?

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* 5. What is your age?

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* 6. What is your highest level of education?

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* 7. Please provide the race or ethnicity that best describes you

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* 8. Questions on Stigma

  Yes No
Do you feel ashamed of your epilepsy?
Do you try to hide your epilepsy?
Do you worry about others finding out about your epilepsy?
Do you feel you should be blamed for your epilepsy?
Does concern about being honest about your epilepsy prevent you from going to the doctor?
Does concern about being honest about your epilepsy prevent you from getting necessary tests?
Are you ever embarrassed by your epilepsy?
Does embarrassment keep you from talking about your epilepsy?
Does embarrassment keep you from getting services that would make your life easier (transportation, etc.)
Do you hide your epilepsy from co-workers?
Do you hide your epilepsy from those you date?
Do you hide your epilepsy from friends?
Do you hide your epilepsy from family?
Do attitudes about epilepsy prevent you from doing things you love?
Do attitudes about epilepsy prevent you from taking care of your health?
Do attitudes about epilepsy have an impact on your financial success?

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* 9. Please share the following

  Yes No
Do you see an epileptologist?
Are you concerned about SUDEP?
Are you concerned about stigma?
Has anyone ever talked to you about rescue medications?

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* 10. Please share the following

0 of 10 answered
 

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