Questionnaire Form - Total Lipedema Care

Total Lipedema Care

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Lipedema
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First Name*
Last Name*
Email*
Phone Number*
Would you like to be contacted by Total Lipedema Care?
- Yes
- No
How did you learn about us?
- Instagram
- Friend
- Google
- Video
Did you hear about Total Lipedema Care or Dr. Jaime Schwartz?
- Total Lipedema Care - @totallipedemacare
- Dr. Jaime Schwartz - @drjaimeschwartz
Have you been officially diagnosed with Lipedema?
- Yes
- No
- No, but I'm pretty sure I have it based on what I've researched
What stage of lipedema do you think you have?
- One
- Two
- Three
- Four
- Unknown
How do you feel about your legs?
- Hopeful
- Hopeless
- I love my legs
- I'm worried for my legs
Do you think your lipedema is genetic?
- Yes
- No
- Maybe
If yes, what is your ethnic background? (If Caucasian, please be as specific as possible, we have been seeing a link to German genetics)
Where do you have pain? (check all that apply)
- Arms
- Front of Legs
- Back of legs
- Calves
- Stomach
- No Pain
At what age did you start to develop signs of lipedema?
Please enter a number from 0 to 100.
At what age did you have your first menstrual cycle?
Please enter a number from 0 to 100.
Would you travel for lipedema surgery?
- Yes
- No
- Maybe
Have you consulted with other doctors about lipedema?
- Yes
- No
If yes, what kind of doctor have you seen?
Have you have previous liposuction or lipedema treatment?
- Yes
- No
- Yes, I'm happy with my results
- Yes, but I'm unhappy with my results
If yes and you are unhappy with your results, please explain why:
Do you wear compression garments?
- Yes
- No
- No, but I'd like to learn more about them
Do you use leg pumps?
- Yes
- No
- No, but I'd like to learn more about them
If yes, what brand do you use?
What is your favorite way to exercise?
- Cardio Machines
- Running
- Walking
- Weightlifting
- Yoga/Bare/Pilates
- I don't exercise
- Other
Have you had liposuction before?
- Yes
- No
Most lipedema patients need more than one surgery, would you be willing to have more than one surgery if needed?
- Yes
- No
Are you part of any lipedema facebook groups?
- Yes
- No
- No, but I’d like to be part of a group
How has lipedema affected your life?
What type of food do you crave?
- Sugar
- Protein
- Carbs/Breads/Pasta
- Salt
- Veggies
We've been researching fatigue and activity levels. Have you experienced depression?
- Yes
- No
If yes, did you experience depression at a younger age before lipedema became apparent?
- Yes
- No
Do you get brain fog and fatigue?
- Yes
- No
Do you have thyroid issues?
- Yes
- No
Is your blood work normal?
- Yes
- No
Do you consider yourself:
- Overweight
- A little overweight
- Average
- Underweight
Do you scar easily?
- Yes
- No
What is your favorite medium of learning about lipedema?
- Google
- YouTube
- Instagram
- Facebook
- Other
What more would you like to see/read/listen to about lipedema and were would you like it posted?
Do you have any questions or thoughts or discoveries or a story you’d like to share?
Name
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