Liver Disease Patient Survey

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* 1. What is your current age?

Under 18

18-29

30-39

40-49

50-59

60-69

70-79

80-89

90 or older

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* 2. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

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* 3. In what city do you live?

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* 4. In what state or U.S. territory do you live?

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* 5. What age were you at diagnosis?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 6. What is your Liver Disease Diagnosis?

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* 7. What symptoms did you experience before diagnosis? Did you have any underlying conditions?

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* 8. How were you diagnosed? (for example: trip to ER, visit to PCP, test)

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* 9. What is your current Liver Disease status?

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* 10. Are you currently being followed by a specialist? If yes, what kind?

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* 11. If applicable, is a liver transplant an option?

Yes

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* 12. At time of diagnosis did you feel you were given adequate information and support?

no support provided

very little support provided

adequate support provided

more than adequate support provided

excellent support provided

no support provided

very little support provided

adequate support provided

more than adequate support provided

excellent support provided

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* 13. After your diagnosis did you try to find out more information?

Yes

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* 14. If you answered "Yes" to the previous question, please specify how.

Online

Non-profit organization

Medical journals

Other (please specify)

Liver Disease Patient Survey

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* 1. What is your current age?

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* 2. What is your race or ethnicity?

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* 3. In what city do you live?

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* 4. In what state or U.S. territory do you live?

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* 5. What age were you at diagnosis?

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* 6. What is your Liver Disease Diagnosis?

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* 7. What symptoms did you experience before diagnosis? Did you have any underlying conditions?

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* 8. How were you diagnosed? (for example: trip to ER, visit to PCP, test)

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* 9. What is your current Liver Disease status?

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* 10. Are you currently being followed by a specialist? If yes, what kind?

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* 11. If applicable, is a liver transplant an option?

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* 12. At time of diagnosis did you feel you were given adequate information and support?

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* 13. After your diagnosis did you try to find out more information?

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* 14. If you answered "Yes" to the previous question, please specify how.

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* 15. How has Liver Disease impacted your life socially, financially or emotionally?

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* 16. What support services would be helpful to you and your caregiver(s)?

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* 17. Please share any additional comments/observations regarding your Liver Disease.