Profiling

Patients Opinion Team

Would like to collect your view. Kindly complete the below pre-screener survey and we will sent you appropriate survey to you soon.

Once you complete our live survey you will win $ 2 to $ 10 for your valuable time.

Your Name:

Your E-mail id:

Your Zip Code:

What is your age:

Country:

Have you been diagnosed with any of the following illnesses/conditions?
**Note that the information will be kept in strictest confidence.

None of the above

Acne

ADD/ADHD

Allergies (not associated with Hay Fever)

Anemia

Angina

Anxiety

Arrhythmia/Atrial Fibrillation

Arthritis

Asthma

Back Pain

Bipolar Disorder

Blood Disorders (non Cancerous)

Bronchitis

Cancer

Cardiovascular Disease

Carpal Tunnel Syndrome

Chronic Fatigue Syndrome

Chronic Kidney Disease

Chronic Lymphocytic Leukemia

COPD

Cirrhosis

Colitis

Constipation

Crohn's Disease

Cystic Fibrosis

Dental Problems

Depression

Diabetes

Diarrhea/Diarrhoea

Eczema

Emphysema

Endometriosis

Epilepsy

Erectile Dysfunction (ED)

Fibromyalgia

Food Intolerances

Gastro Esophageal Reflux (GERD)

Gastroenteritis

Gout

Hemophilia

Hemorrhoids

Hay Fever

Heart Conditions (not heart failure)

Heart Failure

I don't have any illnesses/conditions

Other

Prefer not to answer

If you stated that you have been diagnosed with diabetes, can you define the type of diabetes?

Diabetes Type 1

Diabetes Type 2

Prefer not to answer

I don't have diabetes

Would you like to refer any diagnosed with diabetes types 2 person'semail id for the survey. If yes then kindly share below:

Ref E-mail id: