Treatment

• 1. When were you diagnosed with MS?
• Month January February March April May June July August September October November December Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
• 2. Are you currently treating your MS with any of the following?
• AVONEX^® (interferon beta-1a)
• Betaseron^® (interferon beta-1b)
• Copaxone^® (glatiramer acetate injection)
• Rebif^® (interferon beta-1a)
• Gilenya™ (fingolimod)
• Infusion therapy
• Extavia^® (interferon beta-1b)
• Solu-Medrol^® (methylprednisolone sodium succinate)
• Other
• Not Treating

• 3. What MS Medication(s) have you tried?
  Select all that apply
• AVONEX^® (interferon beta-1a)
• Betaseron^® (interferon beta-1b)
• Copaxone^® (glatiramer acetate injection)
• Rebif^® (interferon beta-1a)
• Gilenya™ (fingolimod)
• Infusion therapy
• Extavia^® (interferon beta-1b)
• Solu-Medrol^® (methylprednisolone sodium succinate)
• Other
• Not Treating

---

MY EXPERIENCE  (OPTIONAL)

While the following questions are optional, we would appreciate your participation. The answers you provide will help us understand your experience so we may better serve you and others living with MS.

• 4. Which of the following best describes your current overall health?
• • 
    Excellent
  • 
    Very Good
  • 
    Good
  • 
    Fair
  • 
    Poor
  • 
    Very Poor

For each of the following statements, please choose a number that best represents your agreement with each statement (1 representing totally disagreeing, 11 representing totally agreeing).

• 5. I would definitely ask my doctor about taking a new potentially more effective MS medication with potentially life-threatening risks as long as I could be carefully monitored.
• • 
    1
  • 
    2
  • 
    3
  • 
    4
  • 
    5
  • 
    6
  • 
    7
  • 
    8
  • 
    9
  • 
    10
  • 
    11
  
• 6. I feel like I am "missing out on life" because I have MS.
• • 
    1
  • 
    2
  • 
    3
  • 
    4
  • 
    5
  • 
    6
  • 
    7
  • 
    8
  • 
    9
  • 
    10
  • 
    11
  

For the next question only, please choose a number that best represents your agreement with the statement (1 representing not at all satisfied, 11 representing extremely satisfied).

• 7. How satisfied, if at all, are you with your current approach to managing/treating your MS? Please consider everything that you are currently doing to manage or treat your MS.
• • 
    1
  • 
    2
  • 
    3
  • 
    4
  • 
    5
  • 
    6
  • 
    7
  • 
    8
  • 
    9
  • 
    10
  • 
    11
  
• 8. My MS makes it difficult to get through the day.
• • 
    1
  • 
    2
  • 
    3
  • 
    4
  • 
    5
  • 
    6
  • 
    7
  • 
    8
  • 
    9
  • 
    10
  • 
    11
  
• 9. It's more important to control the severity of my MS symptoms than to reduce the amount of medication side-effects.
• • 
    1
  • 
    2
  • 
    3
  • 
    4
  • 
    5
  • 
    6
  • 
    7
  • 
    8
  • 
    9
  • 
    10
  • 
    11
  
• 10. I'm always thinking about my MS.
• • 
    1
  • 
    2
  • 
    3
  • 
    4
  • 
    5
  • 
    6
  • 
    7
  • 
    8
  • 
    9
  • 
    10
  • 
    11
  
• 11. I would definitely ask my doctor about taking a new MS medication if it were more effective than the treatments that are currently available.
• • 
    1
  • 
    2
  • 
    3
  • 
    4
  • 
    5
  • 
    6
  • 
    7
  • 
    8
  • 
    9
  • 
    10
  • 
    11
  

Which best describes you?

• Care partner, relative, or friend of someone living with MS
• Healthcare Professional
• Neither