This free survey is powered by
  1. Surveys
  2. 2017
  3. February
  4. R
  5. Reform Dialysis
0%
Exit Survey
 
 
Hello:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
 
Have you ever been diagnosed with a condition because of your Dialysis treatment? If so, which of the following conditions correspond?
 
No
 
Low/High Blood Pressure
 
Nausea and Vomiting
 
Itchy Skin
 
Muscle Cramps
 
Other
 

 
 
 
Do you feel pain or fatigue after your treatments?
 
Yes
 
No
 
 
 
On a scale of 1-10, how healthy would you consider yourself? (1 being sedentary and 10 being healthy)
   
 
 
 
How would you say Dialysis treatment has impacted your quality of life?
   
 
 
 
Have ever had an infection or swelling occur near the access catheter?
 
Yes
 
No

 
 
 
Do you ever feel any itching near the access site during or after procedures?
 
Yes: (Circle One) Before After
 
No