Amputee Experience Survey

Amputee Experience Survey

Help us help others by sharing your journey.
Thank you for taking the time to share your experience.

Your insights will help us create better resources for new amputees. This survey takes about 10-15 minutes to complete. All responses are confidential.
Name
Email*
We'll only use this to send you the final resource when it's ready.
How long ago was your amputation? *
Type of amputation*
Age group*
Gender*
Living situation at time of amputation*
This helps us understand what support was available during your recovery.
🏥 Medical Care & Pain Management
What medical questions did you have in your first week? *
What do you wish medical staff had told you about pain management?*
Which topics were most confusing? (Check all that apply)

Wound care and dressing changesPhantom pain vs. residual limb painMedication managementSwelling and shapingSigns of infection to watch for
🦿Equipment & Prosthetics
What questions did you have about prosthetics that nobody answered?
What equipment do you wish you'd known about sooner?*
Rate how prepared you felt for prosthetic fitting:

1

2

3

4

5

1 is Worst, 5 is Very Well
🏠 Daily Living
What daily tasks were hardest to figure out on your own?
What home modifications do you wish you'd done immediately?*
💰Insurance & Financial Resources
What insurance questions caught you off guard?
What financial resources do you wish you'd known about?
What insurance battles were you unprepared for? (Check all that apply)*

Coverage denialsAppeal processDocumentation requirementsAnnual/lifetime limitsBilling codes and categories
💭 Emotional & Mental Health Support
What emotional challenges surprised you the most?*
What support do you wish had been offered immediately?
Did you have access to mental health support post-amputation? If yes, how would you rate its effectiveness?

1

2

3

4

5

1 is Worst, 5 is Best
⭐ Your Top Priorities
If you could tell a new amputee just THREE things on Day 1, what would they be? *
What single resource would have helped you most?
What questions should EVERY new amputee ask their care team?*
💬 Anything Else?
Is there anything else you'd want in a "New Amputee Checklist"?
By submitting this survey, you consent to the use of your responses for research and resource development purposes. All personal information will remain confidential.
Should be Empty:

Amputee Experience Survey

Thank you for taking the time to share your experience.

🏥 Medical Care & Pain Management

🦿Equipment & Prosthetics

🏠 Daily Living

💰Insurance & Financial Resources

💭 Emotional & Mental Health Support

⭐ Your Top Priorities

💬 Anything Else?