Patient Survey

In our ongoing effort to further meet the needs of seizure patients, we have developed this simple survey. Please note that your individual responses will be kept confidential, and your information will not be sold or shared with any other groups or individuals. When completed, please click the submit button below.

1. How often do you experience seizures? 1-5 times  

2. When a seizure occurs, how long does it usually last?
less than 2 minutes 3 - 5 minutes
5 - 10 minutes 10 minutes or more

3. Do you fear being away from home because of seizures?
yes no

4. Do you refrain from taking vacations because of seizures?
yes no

5. When a seizure occurs, would you prefer treatment in an emergency room (ER) or with an at-home medication (DIASTAT)?
ER At-Home Medication (DIASTAT)

6. Have you ever been treated with DIASTAT to stop a seizure?
yes (please continue to question 7)
no (please skip to the bottom of survey)

7. How long does it take for DIASTAT to stop a seizure?
1 - 3 minutes 4 - 7 minutes
8 - 12 minutes more than 13 minutes

8. Does DIASTAT provide you with increased freedom and control over seizures and your life? yes no

9. Has the use of DIASTAT reduced your visits to the emergency room?
yes no

10. Please tell us how DIASTAT has positively changed your life.


Thank you for taking the time to answer this survey. If you are interested in receiving additional information on DIASTAT or wish to participate in future surveys, please fill out the following.

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