Recurrent Respiratory Papillomatosis Foundation

PATIENT SURVEY
PART 1

Survey Completion
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This is a 3-part survey to update the RRP Foundation comprehensive epidemeological database of patient information. Your personal confidentiality will be maintained at all times. Your name, initials, birthdate, address, phone/fax/or e-mail address will not be included with any shared information, only a unique numeric identifier will be assigned to distiguish responses.

The purposes of this survey are to:

  • Help provide health care information to patients and their families;
  • Provide key information to RRP researchers to help develop new treatments and prevention for RRP.
  • Parts of the survey may be included in a Ph.D. thesis to foster public support for RRP prevention, treatment and research.

The survey design is in 3 Parts:

  1. Patient History and Current Disease Status.
  2. Surgical/Adjuvant Treatment History.
  3. Complications/Costs/Social-economics Issues.

An * indicates an answer is required.
May we share the above data in the unique identifier section for networking purposes when we create a patient/health care provider directory? * Yes
No
May we share your survey responses with RRP researchers? (if “Yes”, we may and if “No” we won’t.) * Yes
No