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A:CARE INSIGHT Questionnaire

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This questionnaire should be based on your own personal experience, please answer as honestly as possible.

1 2 3

Progress : 0 %

It is essential that I follow my treatment plan.

Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

Next

My treatment helps with my condition.

Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

Next

My condition affects my social life.

Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

Next

My condition is likely to get worse if I don’t follow my treatment plan.

Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

Next

I am able to follow my treatment plan.

Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

Next

My condition has led to financial problems.

Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree

*Questionnaire uses SPUR^TM by Observia

GLO2270831-2

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