Brit-PACT Telemedicine Survey for Patients

Section 1:

In this section, we would like to collect some general information about you.

Female

Male

Non-Binary

Prefer not to answer

Other (please specify)

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

If under 18yrs of age please specify:

Paracetamol

NSAIDS (non steroidal anti inflammatory drugs)

DMARDS (Disease-modifying antirheumatic drugs )

Biologic/anti-TNF

Biosimilar

Targeted synthetic tablet

Other - please specify (or if not sure what type of med you take just enter the medication name from the packet below)