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  1. Surveys
  2. 2010
  3. November
  4. V
  5. Vasculitis Foundation
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Hello:
You are invited to participate in an important survey for the Vasculitis Foundation . It will take approximately 5 minutes to complete the questionnaire.

Your participation in this survey will help the Vasculitis Foundation understand how best to communicate with you, our valued partner, and how to increase awareness of our foundation and the work being done to find effective treatments and ultimately cures.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
Please respond to the following statements using a scale of 1 to 5 where:
1= Completely Agree, 2=Somewhat Agree, 3=Neutral, 4=Somewhat Disagree, and 5=Completely Disagree
1 2 3 4 5
I am familiar with the Vasculitis Foundation website
The Vasculitis Foundation website is a main source of information for me
I have referred Physicians/Medical Practitioners to the Vasculitis Foundation website
I have referred patients / patient family members to the Vasculitis Foundation website
 
 
Please rate your likelihood to utilize the following sources for information on Vasculitis using the following scale:
1= Very Likely, 2=Somewhat Likely, 3=Not Sure, 4=Somewhat Unlikely, 5=Very Unlikely
1 2 3 4 5
Read an article on Vasculitis in a medical journal
Read information about Vasculitis brought to you by a patient/perspective patient
Attend a presentation on Vasculitis at a medical conference requiring overnight travel
Attend a local conference / medical education program about Vasculitis
 
 
 
Please tell us three types of information that you would like to see made available from the Vasculitis Foundation:
   
2.
   
3.
   
 
 
 
Please list the top three methods of communication that you would like to see the Vasculitis Foundation utilize:
   
2.
   
3.
   
 
 
 
Would you like further information on the Vasculitis Foundation.
 
No
 
Yes
 
 
Please provide your contact information
* First Name : 
* Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
Phone : 
Email Address : 
 
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