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Thanks for coming - we're looking forward to learning your opinions
First please tell us a little about yourself.
Remember, all information is confidential.
1.
which term best describes you (select the most suitable)
CKD patient
Medical Care provider for a CKD patient
Home care provider (non-medical) for CKD patient
Other (please specify)
2.
Are you male or female?
Male
Female
3.
What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 +
I'd prefer not to answer
4.
When thinking of yourself or your primary patient's CKD, what best describes the stage
Stage 1 through 4
Stage 5 (dialysis)
None of the above
5.
Who is the primary cook in your household?
Me
Significant other
Shared about 50:50
Care provider
Other
6.
How often do you cook your own meals?
Never
Less than 5 meals a week
5-10 meals a week
More than 10 meals a week
7.
How confident or comfortable do you feel with the treatment program for CKD?
Not at all
Quite
Good but could learn more
Very
N/A
Dialysis
Not at all
Quite
Good but could learn more
Very
N/A
Diet
Not at all
Quite
Good but could learn more
Very
N/A
Medication
Not at all
Quite
Good but could learn more
Very
N/A
8.
Where do you typically find information on CKD diet?
Please select the 2 sources that you most often use.
Hospital expert or nutritionist
Internet: general food or diet sources
CKD specialist websites e.g. Kidney Foundation
Other (please specify)