HAE Self-Assessment Questionnaire

  1. When thinking about your attacks, let’s consider what they feel like and how they impact your activities.

  1. With regards to how they feel like, please select all that apply:
  1. With regards to how they impact your activities, please select all those that it interferes with:
  1. Do you know of a family member who has HAE?

Bring this completed questionnaire with you to your next doctor’s appointment so they can see if your HAE treatment needs optimizing.1

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