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My Friend Jen Prescription Payment Support Survey
This survey is for people living with any type of sickle cell, based in the UK, who pay for their prescriptions.
If you do not pay for your prescriptions, please do not complete this form.
Thank you for your understanding.
1.
How many different medications are you prescribed per month?
1 medication
2 medications
3 medications
4 or more medications
2.
Do you have any difficulty paying for your prescriptions?
Yes
No
3.
Have you ever purchased a PPC (NHS Prescription Prepayment Certificate)?
I have never heard of a PPC
No, I have never purchased a PPC
I can't afford A PPC
Yes, I purchase a PPC every 3 months
Yes, I purchase a PPC every year
4.
What area of the UK do you currently live in?
5.
Which race/ethnicity best describes you? (Please choose only one.)
Black / African
Black / Caribbean
Mixed Heritage
White / Caucasian
Multiple ethnicity / Other (please specify)
6.
What is your approximate average income per year?
< £10,000
£10,000 - £20,000
£20,000 - £30,000
> £30,000
7.
Would receiving financial support to pay for your prescriptions be beneficial to you?
Yes
No
8.
If you answered yes to the previous question (Q7), please provide us with your name and best method of contact:
9.
Please explain how receiving financial support to pay for your prescriptions would help you.