Questionnaire for Persons Who Have Had Rat Lungworm Disease
1. Where were you living when you contracted rat lung?
2. Do you know how you got rat lung? Please describe.
3. What were your symptoms?
4. How did you treat it (ie: western medicine, alternative medicine)?
5. Do you still have any symptoms? Please list them.
6. How has rat lungworm affected your life?
7. What preventative measures do you take to keep from getting rat lungworm again?
8. Do you think rat lung affects your community/the state of Hawaii? If so, in what way?
9. What actions would so you think need to be taken about this issue?
We are documenting the numbers of cases of rat lungworm in Hawaii and ask you to write your name and contact information below. If you know of anyone who has had rat lungworm please ask them to contact us at firstname.lastname@example.org or telephone 808 769-2363 or 808 938-1601. This form can be printed out and sent to Survey, P.O. Box 1255, Pahoa, HI 96778.