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  1. Surveys
  2. 2017
  3. April
  4. Z
  5. Zika Virus Clinical Trials
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Questions marked with a * are required Exit Survey
 
 
Have you ever traveled to any of the following countries?
 
Argentina
 
Brazil
 
Africa
 
Uganda
 
Any other countries in Asia or Africa

 
 
 
How familiar are you with the symptoms of Zika Virus?
 
Not Familiar
 
Familiar
 
Very Familiar
 
I only know that Zika is not good for my health.

 
 
 
* List the medications that you are allergic to
   
 
 
 
Have you ever been apart of a clinical study before?
 
Yes
 
No

 
 
 
Would you be apart of the clinical study that would allow your fetus to be protected from microcephaly?
 
Yes
 
No

 
 
 
* List the conditions that your primary doctor has told you that your fetus has once you were exposed to Zika Virus
   
 
 
 
When given the consent form, did the interviewer provide enough details about how the trials would be conducted?
 
Yes, somewhat
 
Yes, certainly
 
No, I do not understand

 
 
 
List the treatments that you have received prior to joining the clinical study