RHEUMATOID ARTHRITIS HISTORY SURVEY

This survey is Confidential. That means that Activity Girl, LLC/Amee Quiriconi have access to information about who took this survey, but this information is not available to anyone outside our business. By keeping the survey results confidential, it means your name will never be associated with your survey response in any kind of reporting. When survey results are reported, they will always be aggregated—that is, individual survey results are combined together and presented as a group. Comments submitted on this confidential surveys will also never be associated with a respondent’s name or ID; however, the comments are reported verbatim in lists sorted alphabetically. Results for groups of fewer than three people are never reported when there is any risk of breach of confidentiality.

To Which Gender do you most identify?
Select as many of the following statements that applied to you growing up
Select as many of the following statements that apply to you today as an adult.
Select all of the statements that best describe your Mother.
Select all of the statements that best describe your Father/Co-Parent (including a stepfather)
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© 2019 Amee Quiriconi & Activity Girl, LLC