Patient input into medication reimbursement decisions - Page 1
Demographic Information
1. What is your gender? Male Female Trans or Two-Spirited
2. What is your age range? Under 20 20-24 25-34 35-44 45-54 55-64 65 and up
3. How long have you been diagnosed with schizophrenia? Less than 5 years 5-10 years 11-15 years More than 15 years
4. Are you currently taking any antipsychotic medications? Yes No
5. Which medications have you tried for schizophrenia/psychosis?
If you have any trouble with the survey, please email info@rgi-graphics.com.