Which of the following conditions have you experienced in the last 12 months?
Acid Reflux/GERD
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Acne
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
ADD/ADHD
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Age Related Memory Loss (moderate or severe)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Allergies
Food Allergy (e.g., peanuts, shellfish)
Grass Allergy
Insect Allergy (e.g., bee stings)
Pet Allergy (e.g., cat/dog dander)
Ragweed Allergy
Tree Pollen Allergy
Other Allergy
Have you ever experienced anaphylaxis?
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Allergies
Anaphylaxis
Treatments (Asked for: Allergies):
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Anemia
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Anxiety (frequently felt anxious, nervous, or worried)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Ankylosing Spondylitis
Osteoarthritis/Degenerative arthritis
Psoriatic Arthritis
Rheumatoid Arthritis
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Ankylosing Spondylitis
Osteoarthritis/Degenerative arthritis
Psoriatic Arthritis
Rheumatoid Arthritis
When diagnosed (Asked for: Rheumatoid Arthritis)
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced??
Asthma
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced??
Bipolar Disorder
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Blood Clots in the Legs (DVT) or Pulmonary Embolism (PE)
Which of the following conditions have you ever experienced?
Blood Clots in the Legs (DVT) or Pulmonary Embolism (PE)
Have you ever experienced a pulmonary embolism (PE)?
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Acute Coronary Syndrome/Heart Attack
Angina
Atrial Fibrillation (A-Fib) or Arrhythmia
Coronary Artery Disease/CAD (sometimes called "hardening" or "clogging" of the arteries)
Other Cardiovascular or Heart Disease
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Acute Coronary Syndrome/Heart Attack
Angina
Atrial Fibrillation (A-Fib) or Arrhythmia
Coronary Artery Disease/CAD (sometimes called "hardening" or "clogging" of the arteries)
Other Cardiovascular or Heart Disease
When diagnosed (Asked for: Atrial Fibrillation (A-Fib) or Arrhythmia)
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
COPD (including Chronic Bronchitis and Emphysema)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Depression
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Type 1 Diabetes
Type 2 Diabetes
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Type 1 Diabetes
Type 2 Diabetes
When diagnosed (Asked for: Type 2 Diabetes)
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Have you used a blood glucose meter in the last 30 days?
How many times per day, on average, do you use a blood glucose meter?
Less than once a day
1-2 times per day
3-5 times per day
6 or more times per day
What features are important to you when choosing a glucose meter/monitoring system?
Alternate site testing
Automatic coding of test strips
Bluetooth capability
Communicates wirelessly with insulin pump
Compact size/portability
Connects directly to my smartphone
Continuous 24/7 monitoring
No finger pricks
Provides insights such as patterns, averages, or estimated HbA1C levels
Results are uploaded automatically to share with doctor/other
Single device monitors blood glucose AND blood pressure or blood ketone levels
Syncs with fitness, diet or medication trackers/apps
Other features
Which of the following diabetes-related complications or conditions have you ever experienced?
Which of the following conditions have you ever experienced?
Diabetic Nerve Pain
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Eczema
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Enlarged Prostate/Benign Prostate Hyperplasia
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Erectile Difficulty (More than one episode)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Cataracts
Dry Eye
Glaucoma
Macular Degeneration
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Cataracts
Dry Eye
Glaucoma
Macular Degeneration
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Fibromyalgia
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Flu
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments (Cold/Flu/Cough):
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Gout
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Hepatitis B
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Hepatitis C
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Herpes
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
High Cholesterol
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
HIV
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Has Disease Progressed to AIDS?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Hyperhidrosis/Excessive Sweating
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Hypertension/High Blood Pressure
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Hypothyroidism/Low Thyroid Function
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Crohn's Disease
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Ulcerative Colitis
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Irritable Bowel Syndrome (IBS)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Kidney Disease
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Low Testosterone
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Lupus
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Migraine Headache
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Are your Migraines Episodic or Chronic?
Episodic (occur occasionally)
Chronic (occur 15+ days a month, with a headache lasting at least 4 hours)
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Multiple Sclerosis
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Obesity
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Osteopenia
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Osteoporosis
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
When diagnosed
In the last 12 months
1 to less than 2 years ago
2 to less than 5 years ago
5 to less than 10 years ago
10 to less than 15 years ago
15 to less than 20 years ago
20 or more years ago
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Overactive Bladder
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Pneumonia
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Post Traumatic Stress Disorder (PTSD)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Psoriasis
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Restless Leg Syndrome (RLS) (also called Willis Ekbom Disease)
Which of the following conditions have you experienced in the last 12 months?
Restless Leg Syndrome (RLS) (also called Willis Ekbom Disease)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Rosacea
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Seizures/Epilepsy
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Shingles
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Insomnia
Sleep Apnea (frequently gasp or stop breathing while asleep)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Insomnia
Sleep Apnea (frequently gasp or stop breathing while asleep)
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Stroke
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Urinary Tract Infection
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Dyspareunia (painful intercourse)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Used an over-the-counter personal lubricant/vaginal moisturizer in the last 12 months
Which of the following conditions have you ever experienced?
Endometriosis
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Which of the following conditions have you experienced in the last 12 months?
Infertility
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Which of the following conditions have you ever experienced?
Menopause (More than 12 months since your last period)
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you experienced in the last 12 months?
Menstrual Cramps/PMS
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Severity:
Mild
Moderate
Severe
Treatments:
How are you treating or did you treat your (condition)?
Which of the following conditions have you ever experienced?
Uterine Fibroids
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Professionally Diagnosed:
You mentioned that you have experienced the conditions below. Which ones were diagnosed by a doctor or other healthcare professional?
Treatments:
How are you treating or did you treat your (condition)?
A single prescription medication may not work as well as expected for treating a particular health condition. In certain cases, taking a second or “add-on” prescription medication can improve symptoms or accelerate the response to treatment. Would you consider taking a second or add-on medication?