The purpose of this questionnaire is to try to capture the impact that myocarditis has had on your life. Your perspective is vitally important to others who are trying to understand the seriousness of this disease. 

Your results will be reviewed and summarized by Myocarditis Foundation staff and the results will be posted anonymously on our website, identified only by your initials.


There are 23 questions in this survey.
  A note on privacy
This survey is anonymous.
The record kept of your survey responses does not contain any identifying information about you unless a specific question in the survey has asked for this. If you have responded to a survey that used an identifying token to allow you to access the survey, you can rest assured that the identifying token is not kept with your responses. It is managed in a separate database, and will only be updated to indicate that you have (or haven't) completed this survey. There is no way of matching identification tokens with survey responses in this survey.		  

[Exit and clear survey]