G6PD Deficiency Survey A

PROFILE of the PARTICIPANT

6% of survey complete.

Goal: To learn more from those who have been diagnosed with Glucose-6-phosphate dehydrogenase (G6PD) Deficiency in order to provide data and information to researchers.
Survey Population: This survey focuses only on those who have already been diagnosed with G6PD Deficiency (G6PDD).
Survey Participant: Refers to the person diagnosed with G6PD Deficiency, though someone else might complete the survey for them. For example an adult might complete for a child. In reports of this survey,

Participants will be referred to anonymously ("a survey participant") and identified by their first name and/or birthdate. All Participants in this survey are guaranteed complete anonymity and confidentiality.

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* 1. Survey Participant First Name (Remember that the Participant is the person diagnosed with G6PD Deficiency, even though someone else might be filling out the questionnaire for them.)

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* 2. Survey Participant Birthdate (mm/dd/yyyy)

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* 3. Survey Participant's sex:

Male

Female

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* 4. Who is filling out this form?

Myself

Biological parent

Doctor

Other (please specify)

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* 5. First Name of person filling out the survey, if other than Participant.

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* 6. Contact email address (your address, or the person who is filling out the form).

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* 7. What country was the Survey Participant born in?

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* 8. What city was the Survey Participant born in?

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* 9. What state (or province or region) was the Survey Participant born in?

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* 10. What best explains your (the Survey Participant’s) ethnic background? Examples: Asian, English, Italian, Polish, Kurdish, African American, Polynesian, Spanish, Irish, Italian. Please be as thorough as possible.

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* 11. Have you (Survey Participant) or someone in your (participant) family been diagnosed of having Mediterranean Anemia?

Yes

No, never heard of this type of anemia.

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* 12. Have you (Survey Participant) or someone in your (participant) family been diagnosed of having Favaism?

Yes

No, never heard of Favaism