Survey - Treatment Survey - National Alopecia Areata Foundation

Spam Control Text: Please leave this field empty

Learn more about registering

About Alopecia Areata
Just Diagnosed?
Living with Alopecia Areata
Research
Our Stories & Photos
Support & Resources
Programs & Events
Products for People with Alopecia
Get Involved

Missing your NAAF family? Reconnect through photos of recent NAAF events. View NAAF Album

Home > Treatment Survey

Treatment Survey

As part of NAAF's commitment to finding an acceptable treatment for alopecia areata, it is important that we adequately understand the needs of our patients so that we can translate this need to the decision makers within targeted Pharmaceutical Companies as well as the Food & Drug Administration (FDA). Please take a moment to complete this survey and let us know just how important alopecia areata treatment options are to you!

*1.

Question - Required - Do you (or your child) currently receive treatments for your alopecia areata?

*2.

Question - Required - If there was an acceptable treatment option that was not covered by your insurance company, how much would you be willing to pay out of pocket? (per month) $0-$20
$21-$50
$51-$100
$101-$200
$201-$400
$401-$650
$651-$1000
over $1000

Question - Not Required - If you answered yes above, does your insurance company currently cover these treatments?

*4.

Question - Required - If there was an acceptable treatment option, what side effects would you be willing to endure?

	Headaches
	Change in Appetite
	Change in Weight
	Skin Rash/hives
	Itching Confusion
	Depression
	Anxiety Drowsiness
	Sleeplessness
	Diarrhea
	Nausea
	Infections

*5.

Question - Required - How important is having an acceptable treatment option for alopecia areata to you (or your child)? Very Important
Important
Moderately Important
Of Little Importance
Not Important

Spam Control Text: Please leave this field empty

NAAF Conference Credit Card Processing

]]