* 1. Please indicate if you are a patient diagnosed with:

* 3. Please indicate your gender:

* 4. How was AF initially detected?

* 5. Please state, as accurately as possible, the length of time between first being aware of symptoms (such as palpitations) to diagnosis:

* 6. What symptoms do you experience (please tick all which apply):

* 8. Which type of clinician manages your AF?

* 9. Which of the following tests have you had?

* 10. Please indicate the medications you are currently prescribed:

* 11. Please indicate any side effects you have experienced from any of the medications taken:

* 12. Have you experienced a TIA or stroke?

* 13. Do you have a history of high blood pressure?

* 14. Have you been diagnosed with Heart Failure?

* 15. Have you undergone any of the following procedures? Please tick all that apply.

* 16. The AF Association would welcome receiving your full case story on life with AF, from detection to treatment and life with AF.
If you would be happy to share your case story please write your email address or contact details below and a member of the AF Association patient services team will contact you.

Please be reassured that your details will NOT be passed to any third party, and no information will be shared without your full permission.

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