Hep Post-Treatment Survey 2016

HEPATITIS C POST TREATMENT SURVEY
Hepatitis C virus (HCV) infection is curable. In clinical trials, roughly 95 percent of those who took the newest medications were cured. Hep C treatment is easier and shorter than ever before. HEP would like to know about your experience with HCV treatment. Please fill out the following survey. We appreciate your feedback.
1) What year were you diagnosed with hepatitis C (HCV)?
2) How long do you think it has been since you contracted hepatitis C?
3) What is your HCV genotype?
4) Have you ever received treatment for hepaitits C?
5) Have you ever received a sustained virological response (SVR) as a result of treatment? (i.e., Did you test negative for the virus 12 weeks after the end of treatment?)
6) What medication(s) did you use? (Check all that apply.)

Other
7) How long were you on treatment?

Other
8) When did you complete treatment?
9) Do you feel better or worse after completing treatment?
10) After treatment did you…? (Check all that apply.)
11) What year were you born?
12) What is your gender?

Other
13) What is your sexual orientation?

Other
14) What is your ethnicity? (Check all that apply.)

Other
15) What is your annual household income?
16) What is your ZIP code?
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HEPATITIS C POST TREATMENT SURVEY