1.What is your gender?

Female

Male

Other (specify)

2.What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

3.How old were you when you were diagnosed with ITP?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

4.What kinds of medications have you tried in the past?

Promacta

Nplate

Doptelet

Other (please specify)

None of the above

5.What were your thoughts on these treatment?

6.Have you ever tried Wayrilz?

Yes

No

7.If yes, what did you like and dislike about the medication?

8.Is there any concern as an ITP patient that you feel is not addressed?