Psychosocial Aspects of Living with an ICD

1. Demographic

 
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You have chosen to participate in the optional portion of the "Predictors of ICD Firing" study. This portion of the study will ask you questions about how having an ICD affects your life. This questionnaire should be completed each time you have a shock from your device and each time you have a routine ICD interrogation or about every 6 months.
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1. Please enter your Study ID #, instead of your name, to maintain confidentialty. If you do not know your Study ID#, please contact the ARVD office via email, cjames7@jhmi.edu or phone, 443-287-5985.
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2. Please enter the date you are completing this questionnaire.
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