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  1. Surveys
  2. 2016
  3. February
  4. A
  5. Awareness of SCD
0%
Exit Survey
 
 
Age:
 
less than 18
 
18-24
 
25-34
 
35 and over

 
 
 
What is your gender?
 
female
 
male

 
 
 
What is your status?
 
freshmen
 
sophomore
 
junior
 
senior

 
 
 
What is your major?
   
 
 
 
Do you know what sickle no disease is?
 
yes
 
no

 
 
 
If you answereed yes to question 5, how did you learn about the disease?
   
 
 
Please answer the following:
Yes No Don't know
Do you carry the trait for sickle cell disease?
Do you have sickle cell disease?
 
 
If you answered yes to any of the questions in question 7, you are required to answer questions 8-10. (If you answered no skip questions 8-10)
Once a month 2-3 times a year Once a year Never
How often do you have painful crises?
How often do you go to the emergency room?
 
 
 
Have you ever been hospitalized due to complications from sickle cell disease?
 
yes
 
no

 
 
 
How many days have you missed school due to sickle cell disease?
 
less than 5
 
5-10
 
10-15
 
greater than 15