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Survey Doctor Office

–

Thank you for taking part in our survey!
You support our work for all affected people!

Important note: No other data will be requested or demanded and the survey is anonymous!

Survey - praxis

Allgemeines

Gender

Male

Female

Diverse

How old are you

Country

1. how long have you had urticaria / when did you receive the diagnosis?

2. what form of urticaria do you have?

acute spontaneous urticaria -> not longer than 6 weeks

chronic spontaneous urticaria -> lasting longer than 6 weeks

2.1 What form, i.e. what is your urticaria triggered by?

Cholinergic urticaria -> Triggered by physical exertion, sport.

Physical urticaria -> Pressure urticaria - Triggered by touch, e.g., drawing on the skin, sitting on a hard surface, tight shoes & clothing

Physical urticaria -> heat urticaria - Triggered by warm temperatures, warm baths.

Physical urticaria -> cold urticaria - triggered by cold temperatures

Physical urticaria -> Aquagenic urticaria - Triggered by contact with water

Physical urticaria -> Light urticaria - Triggered by sun rays & light

Do not know

No education provided by a physician

No information

3. Have you been diagnosed with histamine intolerance in association with the urticaria?

Yes

Now

Has not been diagnosed.

i don´t know

Not specified

4. Are there other cases of urticaria in your family (direct relatives)?

Yes

No

Not Known

Treatment in a clinic (urticaria consultation, etc.)

5. How long did it take you to get an appointment at a clinic specializing in urticaria with outpatient consultations?

0 - 6 Weeks

6 - 12 Weeks

more than 12 weeks

Not specified

6. Have you been examined by a doctor?

Yes

No

Other remarks

7. Did you take pictures of your urticaria to the examination?

Yes

No

7.1 If YES -> Had the doctor also looked at them?

Yes

No

No interest

Other remarks

8. Which examinations were performed by the treating physician in case of chronic urticaria?

No examinations were performed

Bood test

Stool sample

Urine test

Allergty test

Provocation test

further specialist examinations

Not specified

Remarks & Further examinations.

9. Have you received or discussed the result of the examination?

10. What medication was prescribed at the first visit?

Cream

Antihistamine

Cortisone

Emergency medication

Xolair

I did not receive any medication.

Other medication

11. Is your medication effective?

Yes

No

partly / partly

12. What was done or recommended if the medication was not enough?

Nothing

xolair prescribed

cortisone prescribed

Ciclosporin prescribed

Antihistamines prescribed

Changed medication

Higher dosage

Emergency medication

Recommended to other specialist

Shall return

Other remarks

13. Did you have the feeling that you were taken seriously? (Please give a school grade)

14. Did the doctor inform you sufficiently about the disease and its treatment? (Please give a school grade)

15. How would you rate the treatment overall? (Please give a school grade)

Other remarks

16. At what intervals do you talk to your doctor about your disease progression and medication schedule?

17. Were you offered participation in a study

Yes

No

Have rejected

17.1 If YES, in which study did you participate?

17.2 If YOU REFUSED - Why did you refuse? (Concerns, fear of side effects, etc.)?

18. In conclusion, what would you like to tell us?

Falls Du menschlich bist, lasse dieses Feld leer.

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