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Hilliard Law
Gilead ESI Survey
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Case Number
First Name
Last Name
Do you have any social media accounts?
Select
Yes
No
Which social media accounts? (Please select all that apply)
Facebook
Instagram
Twitter
YouTube
LinkedIn
WhatsApp
WeChat
Tumblr
Pinterest
Please list any other social media accounts?
Do you have an email account?
Select
Yes
No
Email account 1
Email account 2
Are your text messages, voicemails, voicemail transcripts, or instant messages stored in a location outside of your cell phone? (i.e., iCloud, email, etc.)
Select
Yes
No
Which ways do you store text messages, voicemails, voicemail transcripts, or instant messages? (Please select all that apply)
iCloud (or any other cloud storage)
Google (i.e. Google Messenger / Google Drive / etc.)
Email
Computer
App
Please list any other ways do you store text messages, voicemails, voicemail transcripts, or instant messages?
Have you made any communications (posts/comments/messages) via social media, text, or e- mail regarding kidney issues?
Select
Yes
No
Please select from the list any communications (posts/comments/messages) via social media, text, or e-mail regarding kidney issues? (Please select all that apply)
Kidney disease
Kidney transplant
Abnormal kidney function
Dialysis
Lab tests
Lab results
Medications
Treatment
Scheduling of doctors appointments
Hospital stays
Doctors
Any other communications (posts/comments/messages) via social media, text, or e-mail regarding kidney issues?
Have you made any communications (posts/comments/messages) via social media, text, or e- mail regarding bone injuries?
Select
Yes
No
Please select from the list any communications (posts/comments/messages) via social media, text, or e-mail regarding bone injuries? (Please select all that apply)
Osteoporosis
Osteopenia
Ostemalcia
Bone fractures
Broken bones
Bone weakening
Bone demineralization
Treatment
Bone pain
Lab Tests/Scans
Medications
Scheduling of doctors appointments
Treatment
Hospital stays
Doctors
Please list any other communications (posts/comments/messages) via social media, text, or e-mail regarding bone injuries?
Have you made any communications (posts/comments/messages) via social media, text, or e- mail regarding HIV medications?
Select
Yes
No
Please select from the list any communications (posts/comments/messages) via social media, text, or e-mail regarding HIV medications? (Please select all that apply)
General comments about taking HIV medications
Scheduling doctors appointments for HIV medications
Viread
Truvada
Atripla
Complera
Stribild
Treatment
PrEP
Genvoya
Biktarvy
Insentress
Combivir
Descovy
Please list any other communications (posts/comments/messages) via social media, text, or e-mail regarding HIV medications?
Have you made any communications (posts/comments/messages) via social media, text, or e- mail regarding emotional injuries?
Select
Yes
No
Please select from the list any communications (posts/comments/messages) via social media, text, or e-mail regarding emotional injuries? (Please select all that apply)
Scheduling doctor/therapy appointments, etc.
Depression
Anxiety
Pain
Suffering
Please list any other communications (posts/comments/messages) via social media, text, or e-mail regarding emotional injuries?
Have you had any communications including but not limited to comments/posts/messages related to the lawsuit against Gilead?
Select
Yes
No
Are there any other ways that you have had communications related to the lawsuit against Gilead?
Comments
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