Wet AMD Patient Survey

The Angiogenesis Foundation and AMDF created this survey to help people with AMD get better care and treatment. Please fill out this survey if you are receiving injections for wet AMD (or have someone assist you in filling out the survey).

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* 1. Please indicate your current age.

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* 2. In what state or U.S. territory do you live?

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* 3. What is your gender?

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* 4. How long have you had wet AMD?

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* 5. How long did you experience vision symptoms before talking to your doctor?

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* 6. How frequently do you receive injections for wet AMD?

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* 7. How important is it to you that you make it to every injection appointment?

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* 8. What has happened to your vision since you started receiving injections?

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* 9. Have you ever missed an injection or taken time off treatment?

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* 10. Have you ever experienced any vision loss after missing an injection or taking time off treatment?

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* 11. What would losing your vision mean to you? Check all that apply.

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* 12. Please check one of the following.

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* 13. Which of the following is the biggest challenge you experience regarding your treatment for AMD? Check all that apply.

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* 14. If you had a question about AMD outside of your eye appointments, where would you go to get the information you needed? Check all that apply.

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* 15. You are receiving treatments that can prevent blindness. If you could help others by spreading the word, would you be willing to do it?

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* 16. Put a check next to the following statements if you agree with them.

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