HAEA and Children’s Music Fund (CMF) Music Therapy Questionnaire
The HAEA is looking forward to working with The Children's Music Fund (CMF) to offer Music Therapy to children with HAE.

The Children's Music Fund was founded by Dr. Raffi, an HAE treating physician based in Los Angeles who has seen first hand the medicinal affect that music can have on individuals coping with a chronic illness.

We would like to understand the level of interest from you, our HAEA community for Music Therapy as part of journey in managing HAE.

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Please indicate if this is filled out for:
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If you are completing this for your child, please provide your child's name. If you are completing this for yourself, please provide your name.
1. What is your or your child's gender?
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2. What is your or your child's age?
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3. Have you ever suffered from pain, fear or anxiety with relation to your HAE and swelling attacks?
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4. What coping mechanisms have you used to overcome pain, fear, anxiety? More than one entry permitted.
5. What kind of barriers have you encountered that prevented you from using these coping mechanisms?
6. Has music ever helped relieve your pain, fear, anxiety, or mood?
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7. Has music ever helped relieve your physical symptoms?
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8. How familiar are you with the benefits of Music Therapy (with a Music Therapist)?
Not Familiar
Very Familiar
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9. Have you ever used Music Therapy (with a live or virtual Music Therapist)?
10. If you have used Music Therapy, how helpful was it in relieving your pain, fear, anxiety, or mood?
Not Helpful
Very Helpful
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11. How interested would you be in receiving Music Therapy during medication (ie infusion or injection of medication)?
Unlikely
Likely
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12. How interested would you be in getting Music Therapy during an HAE attack (in addition to your standard therapy)?
Unlikely
Likely
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13. How interested would you be in getting Music Therapy to help with you coping skills (ie help overcome pain, fear and anxiety)?
Unlikely
Likely
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