Short member survey

Age (parent complete for child):
List your immune deficiency:
If "other", list the name of your immune deficiency:
How long did it take to diagnose your Immune deficiency?:
Are you/is the patient?
Are you on IVIg?
Which brand?
How often do you have your treatment?
Do you pay for your IVIg?
How much does it cost you to have your IVIg? (e.g. car parking, transport fees, food, drinks) month?: $
Has being on IVIg improved your infections?
Are you on SCIg?
Which SCIg product do you use?
How often do you have your SCIg treatment?
How many needles do you use?
Which sites do you use?
Do you pay a fee to pick up your SCIg product from the hospital?
How much does it cost you to pick up your SCIg product from the hospital each month?: $
Estimate the cost of your pump, needles and consumables per year: $
Has being on SCIg improved your infections?
If you are not on SCIg, do you want to be?
What is the reason given by your immunologist as to why you are not on SCIg?:
If not on immunoglobulin replacement therapy, what treatment do you have?
What brand?
How often do you have treatment?
Which infections do you suffer from the most?
Estimate the cost of your treatment per year: $
Has your treatment improved your infections?
Are you on prophylactic antibiotics?
List which prophylactic antibiotic(s) you are prescribed:
Has being on prophylactic antibiotics improved your infections?
If you are not on prophylactic antibiotics, how many times in the last year were you prescribed antibiotic? (include repeats)
List which antibiotic(s) you are prescribed for your infections:
Aside from your immune deficiency, which is the worst co-morbidity (other condition) you have?:
Have you ever had..
Have you had..
Other treatment/major event (if not listed):
Have you heard of CSL?
Have you heard of Grifols?
Have you heard of Shire?
Do you feel these companies support the PID community?
Do you feel these companies support diagnosis and treatment efforts?
Do you have private health insurance?
If yes, which private health insurer?
As far as your PID goes, would you say your health insurance provider is:
Do you think the government recognises immune deficiency as chronic and debilitating?
Do you receive Centrelink disability payment?
Do you receive NDIS payment(s)?
What would be your total financial costs per year to manage your PID?
Where have you found the most information about your PID?:
What do you wish you had known at the beginning of your PID journey, that you know now?
What are some of the greatest challenges you/your family face dealing with PID?
Do you think that being a member of IDFA has helped your PID journey?
What is your name/patient name? - (Please note you do not have to submit your name):
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