Have you or someone you know been diagnosed with chronic viral hepatitis B or C? Yes No What is your relationship to the person with chronic viral hepatitis B or C? Self Family member Friend Other What is your/their age? Years: <30 30-39 40-49 50-59 60-69 70+ How long ago were you/they diagnosed with chronic viral hepatitis? 1-6 Months 7-12 Months 2-3 Years 4-5 Years 6 + Years With what type of chronic viral hepatitis were you/they diagnosed? Hepatitis B Hepatitis C How did you/they come to know about the chronic viral hepatitis condition? Routine physical Blood bank Symptoms Other Were you/they offered alfa-interferon treatment? Yes No If treatment was refused, what was the primary reason? (check one only) Treatment-related side effects Low effectiveness Cost Self-injection drug administration Other What was the specialty of the physician who diagnosed you/them with chronic viral hepatitis B or C? Gastroenterologist Hepatologist Internist Family Practitioner Infectious Disease Other What medications have you/they had or are currently taking to treat chronic viral hepatitis? (please check all that apply) INTRON® A (Interferon alfa-2b, recombinant) for Injection REBETRON™ Combination Therapy containing REBETOL® (Ribavirin, USP) Capsules and INTRON® A (Interferon alfa-2b, recombinant) Injection Roferon A®* (interferon alfa 2a) Infergen®+ (interferon alfacon-1) Not taken medication Don’t know Other *Roferon A® is a registered trademark of Hoffman-   La Roche. +Infergen® is a registered trademark of Amgen, Inc. Have you/they had to discontinue treatment for any reason? Yes No If yes, what was the reason? Treatment-related side effects Cost Inconvenience Lack of response to treatment Other How many INTRON A prescriptions have you/they filled in the last year? 0 1-3 4-6 7-12 13 + How many REBETRON Combination Therapy prescriptions have you/they filled in the last year? 0 1-3 4-6 7-12 13 + Are you/they: Male Female How did you hear about this web site? Television Magazine Newspaper Mail Information from the doctor’s office Electronic search Word of mouth How helpful do you find this website? Very helpful Somewhat helpful Not very helpful No help at all In which area(s) of the website would you like to see more information? (Please check all that apply.) Basic explanation of chronic hepatitis Advanced explanation of chronic hepatitis Treatment options Treatment with INTRON® A Treatment with REBETRON Combination Therapy Providing support to someone with chronic hepatitis Living with chronic hepatitis May we contact you in the future to ask your thoughts on products and services offered by Schering Corporation? Yes No To receive free information about hepatitis treatments by mail, please provide your name and address. We view the protecting the privacy of this information as very important. Please click here to learn more about what we will and won’t do with the information you provide. Name Address City State  ZIP E-Mail