Tell us about you

This survey is provided by the National Infusion Center Association (NICA) and Infusion Access Foundation (IAF).

We use this survey to learn more about the people we serve: anyone who needs infusions or injections that are usually delivered in a medical clinic. If we see that people are experiencing common problems, we use the information provided to share specific examples of how these problems impact real people with legislators and decision-makers when we advocate for change.

Ann Lewandowski, our Director of Patient Empowerment, may reach out to you. You can reach out to her at ann.lewandowski@patientaccess.org if you have specific issues you want to discuss or if you want to get involved.

Please answer honestly and to the best of your ability. If there is a question you are uncomfortable answering, please answer "n/a" or "decline to answer."

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National Infusion Center Association & Infusion Access Foundation Consent and Release Form.

National Infusion Center Association & Infusion Access Foundation Consent and Release Form.

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* 1. By clicking "I agree", you confirm you have read, understand, and agree to the terms in the National Infusion Center Association & Infusion Access Foundation Consent and Release Form.

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* 2. Your contact information

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* 3. We are looking for people who use infusions/injectables to share how important these medications are.
Are you interested in joining the Infusion Champion team?

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* 4. Please provide your diagnosis if you feel comfortable sharing it.

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* 5. What infusion or injectable medicine do you currently take? Please only tell us about the infusions or injections you receive in a clinic.

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* 6. Have you ever had issues or roadblocks receiving your infusion/injection?

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* 7. Do you have or need help paying for your infusion/injection?

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* 8. Has your insurance company ever told you that you have to take a different medicine than the one your doctor recommended/prescribed?

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* 9. Has your insurance ever changed its rules forcing you to find another infusion clinic?
For example, did they need prior authorizations or order medicine from a special pharmacy?

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* 10. Has your insurance ever told you to switch to a new infusion or injection even though your current treatment was working?

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* 11. Please share as much as you are comfortable about you or your health in the comment box below.

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