Lupus Patient Survey
Tell us a bit about yourself!
The California Lupus Foundation is committed to helping lupus patients with free support and education programs. We do this by direct fundraising, sponsorships and grants. Many of the sponsorships and grants request information on details of who we serve. You can help us by answering these few questions. This is completely anonymous, we will have no way of telling who completed the survey. Your answers will help us as we look for funding and will help us decide on new programs to support lupus patients! So please, take a few minutes tell us about yourself! Feel free to let you other lupus patients know about the survey as well!
Lupus Patient Survey
Tell us a bit about yourself!
How long have you had lupus?
Recently Diagnosed
2-5 Years
5-10 Years
Over 10 Years
How old were you when diagnosed ?
Under 18
18-25
26-35
Over 35
How long did it take for you to be diagnosed?
Less than a year
1 year
2-5 years
Over 5 years
What gender are you?
Female
Male
Prefer not to say
What is your ethnicity
African American
Asian
Hispanic/Latin American
Caucasian
Do you have family member with lupus
No, I am the only one with lupus
Yes, my mother/father has/had lupus
Yes, I have a sibling(s) with lupus
Yes, I have cousins with lupus
Do you have any other Auto-Immune Conditions?
What Country do you live in?
What City, State do you live in?
Are there any programs that you would like to see us offer?
Would you like to join our mailing list?
Yes
No, thank you
Email
example@example.com
Submit
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