Question 1/16

Have you been diagnosed with high blood pressure/hypertension?

Yes
No

Question 2/16

Does hypertension run in your family?

Yes
No

Question 3/16

Are you a smoker?

Do you consider yourself to be any of the following?

Question 4/16

Question

Question 6/16

Are you currently satisfied with your treatment?

Yes
No

Question 7/16

Please explain why are you dissatisfied with your current treatment

Question 8/16

Are you interested in changing your treatment?

Yes
No

Question 9/16

What treatment(s) are you interested in switching to

Question 10/16

Have you been diagnosed with Pulmonary Arterial Hypertension (PAH) ?

Yes
No

Question 13/16

Do you currently have medical insurance?

Yes
No

Question 14/16

Please select your current medical provider

Question 15/16

What is the name of your provider?

Question 16/16

lease select the current medical coverage you have