Rx Bandz Patient Survey

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* 1. Do you or an immediate family member own an auto-injector (for example, an EpiPen for allergies), etc.?

Yes

No

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* 2. Have you ever used an auto-injector (for example, an EpiPen) for allergies. Please consider use for both emergency and practice situations. (Select all that apply)

Yes, I have used on myself

Yes, I have used on someone else

No, I have never used one

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* 3. How frequently or infrequently do you carry your auto-inject with you when you are ‘on the go’ (as opposed to being home)? (Select one)

Always

Frequently

Sometimes

Rarely

Never

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* 4. IF ANSWERED "Always" IN Q3, SKIP THIS QUESTION. What are the main reasons that you don’t carry the auto-injector with you at all times? (Type in response)

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* 5. Please share your experiences carrying an auto-injector. What do you like and what do you wish you could change?

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* 6. What features in an auto-injector are most important to you?

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* 7. Is there anything else you would like to share?

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* 8. Would like to join our mailing list to receive the latest news about our auto-injector? If so, then please provide your email below.

Thank you for your time! We truly value your input.

Name

Email Address