How Are You Feeling After
Your Kidney Transplant?

This questionnaire will help your transplant team assess certain side effects you may be having due to your transplant medications. Please check the answer that best describes your experience for each of the following questions.

1.	Have you recently experienced any of the following symptoms?
	a.	Heartburn/indigestion
		Never	Sometimes	Often
	b.	Bloating
		Never	Sometimes	Often
	c.	Stomachache
		Never	Sometimes	Often
	d.	Nausea
		Never	Sometimes	Often
	e.	Diarrhea
		Never	Sometimes	Often
	f.	Thirst
		Never	Sometimes	Often
	g.	Headaches
		Never	Sometimes	Often
	h.	Numbness or tingling in hands or fingers
		Never	Sometimes	Often
	i.	Weight gain or loss
		Never	Sometimes	Often
	j.	Excessive hair growth
		Never	Sometimes	Often
	k.	Depression
		Yes	No
2.	Have you been experiencing any of these problems for longer than 3 months?
		Yes	No
3.	How frequently do any of these problems interfere with eating or sleeping?
		Never	Sometimes	Often
4.	How frequently do any of these problems interfere with work or physical activity?
		Never	Sometimes	Often
5.	Have you taken any over-the-counter medications for these symptoms?
		Never	Sometimes	Often
6.	Have you ever been tempted to skip a dose, delay time between doses, or reduce the dose of any of your transplant medications because of any of these problems?
		Yes	No
7.	Have you ever actually skipped a dose, delayed time between doses, or reduced the dose of your transplant medications because of any of these problems?
		Yes	No

We want you to know we respect your privacy and your information. The information that you enter in the questionnaire is only active for the duration of your visit to the site, and is deleted as soon as you leave the site. It is not saved, or recorded, or in any way linked to any other information that you may submit in this Web site. We welcome your review of the Novartis Privacy Policy by clicking here or by calling 1-888-NOW-NOVA (1-888-669-6682) Monday - Friday, 8:30 AM - 5:00 PM Eastern time.

Click here for complete prescribing information, which includes contraindications, warnings, precautions, and adverse events.

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