Diagnosed Medical Conditions Question Title * 1. MURRAY HILL CENTER A NATIONAL MARKET RESEARCH COMPANY HAS BEEN COMMISSIONED TO INTERVIEW PARTICIPANTS FOR AN UPCOMING PROJECT. THIS WILL BE A 90 MIN LONG FOCUS GROUP AT AN EASY TO REACH LOCATION. IF YOU ARE INTERESTED IN THE PAID (175.00) PLEASE ANSWER ALL OF THE QUESTIONS Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 2. What is your gender? Male Female Question Title * 3. How old are you? Under 17 18 - 24 25 – 34 35 – 39 40-49 50-55 56+ Question Title * 4. Have you been diagnosed with sickle cell disease? Yes No Question Title * 5. In the past week, did you stay in the hospital overnight because of a pain crisis? Yes No Question Title * 6. In the past month, did you stay in the hospital overnight because of any emergency heart problems or other emergency problems? Yes No Question Title * 7. In the past month, did you have any unplanned blood transfusions? Yes No Question Title * 8. Have you had at least TWO pain crisis in the past year? Yes No Question Title * 9. Do you currently take a medication called hydrea (or hydroxyurea)? Yes No Question Title * 10. If you qualify for this project, you must provide a signed form from your doctor. Are you willing to do this? Yes No Done