Louisiana Lupus Foundation Member Survey
Your responses will help the Louisiana Lupus Foundation provide support and resources to you through this worldwide health pandemic. We will discuss these at the upcoming group meeting. A prize will be sent to two random participants during the Sat., April 25 meeting. You will receive meeting details after you submit this form.We are here to support you.
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What support group is nearest you?
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How long have you lived with a lupus diagnosis? *
What treatments or medicines are you currently taking or have taken to treat lupus in the last six months? (Check all that apply) *
Have you tested positive for coronavirus or COVID-19? *
Have you been treated for any of the following health issues in the last 6 months? *
Are you in the home with someone who tested positive for COVID-19 / coronavirus? *
Did you get a flu shot this season? Either in 2019 or 2020. *
Since the coronavirus arrived in Louisiana, have you had any difficulty with one or more of the following? (Select all that apply) *
On average, how many hours do you sleep a day? (Include naps) *
Are you currently in a flare? *
What helps you cope with the complications of lupus or bring you relief?
Who lives with you? *
Are you currently *
Do you have a living will or advanced directive?
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Do you have any fears or concerns about living with lupus during this coronavirus spread that you would like to discuss with other members? *
Do you have any emergency needs? If so, provide as much detail as possible and include your contact information. *
Email address or phone number (optional)
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