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* 1. I am a:

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* 2. Personal Details

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* 3. Please indicate in which of the following way(s) thalassaemia affects your life (You may select more than 1 option).

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* 4. There are new scientific advances now for the care and cure of thalassaemia. Please indicate how you have been informed about them.

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* 5. Please indicate what is your understanding about gene therapy in thalassaemia, based on your knowledge (You may select more than 1 option).

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* 6. Do you know the process and the steps and medical interventions that are involved in gene therapy?

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* 7. Are you aware of the criteria a patient must fulfil in order to be a candidate for gene therapy?

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* 8. Please indicate how you feel about gene therapy?

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* 9. What do you think the benefits of gene therapy will be for a thalassaemia patient?

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* 10. On the basis of the what you know about gene therapy, and if you meet the selection criteria, would you choose to undergo gene therapy?

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