NPF Patient Navigation Center Participant Intake Questionnaire

Thank you for contacting the National Psoriasis Foundation Patient Navigation Center (PNC) and providing your input on living with psoriatic disease.

Using the data you provide, your Patient Navigator will be able to:

Better understand your current status of psoriatic disease
Provide you with information to help you on your journey towards a healthier life

Your de-identified data contributes to a better understanding of how psoriatic disease impacts lives. It also provides information for NPF to better advocate for those living with psoriatic disease.

Please answer the following questions about your psoriatic disease. Your responses will be kept confidential.

White or Caucasian	Black or African American
Asian or Asian American	American Indian or Alaskan Native
Native Hawaiian or other Pacific Islander	Other race
Prefer not to answer

Health care provider	NPF website
NPF e-newsletter	NPF podcast/webinar
Psoriasis Advance magazine	Friend or family member
Google	Facebook
Other social media	Other

Cardiovascular disease including heart attack and stroke	Metabolic syndrome
Obesity	Hypertension (high blood pressure)
Dyslipidemia (high level of cholesterol or fats in the blood)	Diabetes
Anxiety	Depression
Inflammatory bowel disease	Uveitis
Rheumatoid arthritis	Other arthritis
Other

NPF Patient Navigation Center Participant Intake Questionnaire

Demographics

Psoriatic Disease

Comorbidities

Insurance

Health Care Provider

Treatment

Goals

Patient Navigation Center (PNC)