We are trying to determine the impact of COVID19 on our patients with epilepsy, and their care. We would be grateful if you could complete the following questions.
For person completing this survey:

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* 1. Are you?

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* 2. In what country do you live?

You/person with epilepsy during the COVID-19 crisis

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* 3. Have you/your child or another member of your household been diagnosed with COVID-19?

  Me My child/person I look after Household member
Yes, tested positive
Presumably yes (fever, dry cough, shortness of breath, diarrhea or other COVID like symptoms and positive chest xray/CT)
Possibly yes (fever, dry cough, shortness of breath, diarrhea or other COVID like symptoms but no tests done)

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* 4. Has the seizure frequency changed for you/or person with epilepsy during the COVID-19 period?

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* 5. Have you/or person living with epilepsy had difficulty obtaining medication?

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* 6. Have you/or person living with epilepsy had difficulty accessing your epilepsy health care professionals or support team during the COVID-19 period?

For persons with epilepsy:
The following questions ask about how you have been feeling during the past 30 days. For each question, please check the number that best describes how often you had this feeling.

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* 7. Your wellbeing during the COVID-19 crisis.

During the last 30 days, about how often did you feel...

  All of the time Most of the time Some of the time A little of the time None of the time
... nervous?
... hopeless?
... restless or fidgety?
... so depressed that nothing could cheer you up?
... that everything was an effort?
... worthless?

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* 8. In relation to Covid-19, please let us know if any of the following are causing you anxiety at the current time?

  A lot of anxiety A little anxiety No anxiety
Worry about getting COVID-19
Worry about having to self-isolate with epilepsy
Interruption to family or social life / isolation
Worry about seizures worsening/ recurring
Worry about financial/ employment matters
Lifestyle changes (not getting enough sleep, exercise; poor diet or difficulty getting food)
Caring for others

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* 9. Is there specific information/support you feel you need at this time?

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