On whose behalf are you researching Lupus on the Internet?
  
Select
Yourself
Wife or Husband
Daughter or Son
Mother or Father
Other Relative
Friend 
Patient
No one in particular


Have/Do you (or the person indicated above):
  
Select
Been definitively diagnosed with Lupus
Suspect that you might have Lupus
Told by a doctor that you MIGHT have Lupus
Neither of the above


If you (or other person) have been definitely diagnosed, how long ago
were you diagnosed?
  
Select
Less than 3 months
Between 2 and 6 months
Between 6 months and 1 year
Between 1 and 2 years
Between 2 and 5 years
More than 5 years
Have not been diagnosed


If you (or other person) have not yet been diagnosed, have you sought medical
care for the suspicious, Lupus-like symptoms you are currently experiencing?
  
Select  
No
Yes


Why are you researching Lupus on the Internet?
  
Select
You (or the person indicated in #1 above) have been diagnosed with Lupus
Suspect you (or #1 above) might have the condition
You are a medical professional (doctor, nurse, etc.)
Just curious


Do you make regular use of a Lupus and/or healthcare related website/email?
  
Select
Yes
No  If so, what website? 

How useful have you found the Internet for learning about medical conditions?
  
Select
Not useful
Useful
Very useful


How useful have you found this Lupus website (and Clincal Overview)?
  
Select
Not useful
Useful
Very useful


Would you subscribe to a monthly newsletter about Lupus?
  
Select
Yes
No

Would you pay for second opinion and/or medical consultation with
a Lupus specialist through the Interent?
  
Select
Yes
No

Please RANK the following topics according to your INTEREST:
                           Most  | Second | Third  | Fourth  |  Fifth
Diagnosis                      |      |     |      |    
Current Treatment Mehtods      |      |     |      |    
Treatment Research             |      |     |      |    
Cure Research                  |      |     |      |    
Lifestyle Advice               |      |     |      |    

What is the most you would pay for an electronic newsletter covering
these topics?
  
Select
$200
$100
$ 50
$  0


What is the most you would pay for 6 months of individualized medical
consulation through the Internet?
  
Select
$1000
$ 500
$ 300
$ 100
$   0


Have you ever paid for specific access to a website or email service?
  yes   no

How long have you been using the Internet?
   years (use decimals for months)

How would you describe your Internet use?
  
Select
Daily
Three or Four times a week
Once or twice a week
Infrequent

What question would you like answered? (please be concise)
  

General comments, suggestions, feedback.
  
 
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Email  City, State, Country