Hereditary Angioedema (HAE) (MR)

All information collected during surveys or phone discussions will be completely confidential in that we will not show your name or any other identifying information to our clients.

Question Title

* 1. Are you a member of the Hereditary Angioedema Association

YES

Other (please specify)

Question Title

* 2. Are you currently "on" treatment?

YES

Other (please specify)

Question Title

* 3. What treatments have you utilized in the past 12 months?

Question Title

* 4. Please provide basic information so we can contact you when next survey is in progress.

Name: *

ZIP:

Email Address: *

Phone Number:

Thank you very much for taking the time to fill out this short questionnaire. We are collecting basic information to match individuals with specific survey requirements in order to invite your participation.