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Start the conversation with your doctor

This discussion guide is intended to assist with recording your experience with polyneuropathy caused by hATTR amyloidosis.

Take it to your next doctor's visit. It may help guide your conversation about the disease.

By submitting this form, I agree to the Alnylam Privacy Policy. I am 18 years or older, a US resident, and consent to the processing of my personal data per the terms outlined in the Data Privacy Notification and Consent.

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Question 1 of 7

When were you diagnosed with the polyneuropathy caused by hATTR amyloidosis?

Choose the range that applies to you.

Less than a year ago
2 to 4 years ago
1 to 2 years ago
5+ years ago

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Question 2 of 7

Are you experiencing any of these symptoms?

Check all that apply.^a

Burning pain
Severe constipation
Carpal tunnel syndrome
Unintentional weight loss
Decreased reflexes
Vomiting
Difficulty walking
Abnormal sweating
Temperature sensitivity loss
Difficulty urinating
Tingling and/or numbness
Dizziness upon standing
Weakness
Recurrent urinary tract infections
Diarrhea
Sexual dysfunction
Feeling full quickly
Other
Nausea
I have not experienced any symptoms

^aThis is not a complete list of symptoms that may be experienced with hATTR amyloidosis. Having some of the symptoms listed above does not necessarily mean you have the polyneuropathy caused by hATTR amyloidosis. Only a healthcare professional can diagnose your disease.

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Question 3 of 7

Do you feel that your symptoms are worsening?

Yes
No

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Question 4 of 7

Have symptoms disrupted your quality of life?

Select level of impact.

0

10

5

Less

More

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Question 5 of 7

Are you currently receiving treatment for the polyneuropathy caused by hATTR amyloidosis?

Yes
No

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Question 6 of 7

What treatment considerations would you like to discuss with your doctor?

Check all that apply.

Treatment efficacy
Dosing
Potential side effects
Other

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Question 7 of 7

Additional questions to ask your doctor.

Select any question(s) you would like to discuss at your next doctor visit.

How does AMVUTTRA® work?
Which symptoms can AMVUTTRA
treat?
Is AMVUTTRA an appropriate treatment for me?
What are the potential side effects?
How was AMVUTTRA studied?
How is AMVUTTRA given?
What are the potential benefits of treatment with AMVUTTRA?
What should I know about starting treatment with AMVUTTRA?

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