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* 1. Name (first and last)

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* 2. Email

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* 3. How did you learn about We Are ILL’s MS Awareness Month campaign, Shop Chats?

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* 4. Name of Salon/Hairstylist (If you choose Salon/Hairstylist in Q3)

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* 5. Name of Instagram account (If you choose Instagram in Q3)

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* 6. Did you watch the panel discussion video?

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* 7. Did you read or receive the informational pamphlets?

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* 8. Prior to engaging with We Are ILL’s MS Awareness Month campaign, were you familiar with the organization?

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* 9. Before engaging with this campaign, how familiar were you with multiple sclerosis (MS)?

After engaging with this campaign, how would you rate your understanding of the following topics? (Rate each on a scale of 1–5, where 1 = No understanding and 5 = Strong understanding)

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* 10. Symptoms and impact of MS

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* 11. Disparities in MS diagnosis and care in the Black community

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* 12. The role of organizations like ours in supporting people with MS

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* 13. Do you have a personal connection to multiple sclerosis (MS)?

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* 14. What is your connection to MS?

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* 15. Did you find the hair salon setting for the panel discussion relatable or impactful? Why or why not?

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* 16. On a scale of 1–5, how engaging did you find the panel discussion video? 1 = Not engaging at all, 5 Extremely Engaging

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* 17. Did the informational pamphlets provide clear and useful information?

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* 18. How relevant and informative did you find the content of We Are ILL’s MS Awareness Month campaign?

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* 19. As a result of this campaign, are you more likely to do any of the following? (Select all that apply):

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* 20. Having engaged with this campaign, how likely are you to seek a second opinion or speak to a medical professional about your symptoms for a potential diagnosis?

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* 21. Do you feel more confident advocating for or supporting someone with MS after engaging with this campaign?

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* 22. After watching the panel discussion, do you feel more empowered to seek a healthcare provider that is a better fit for your needs?

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* 23. What is one thing you learned from this campaign that you didn’t know before?

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* 24. Do you have any additional feedback about the campaign?

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* 25. Do you currently live with any medical conditions? If so, please list the condition(s) below.

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* 26. Medical condition(s) you currently live with.

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* 27. What’s your age range? (multiple choice, required response)

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* 28. How would you describe your race or ethnicity? Please select all that apply.

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* 29. Where are you located (please provide zip code)?

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* 30. Would you like to be added to We Are ILL’s mailing list?

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