Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Taste comparison *

Compared to XYREM (old drug), please select the option that best describes how XYWAV (new drug) tastes

(1) Much worse than XYREM

(2) Worse than XYREM

(3) Slightly worse than XYREM

(4) The same as XYREM

(5) Slightly better than XYREM

(6) Better than XYREM

(7) Much better than XYREM

Cataplexy days on Xyrem

(Skip if you don't have cataplexy) On average, how many days per week did you have episodes of cataplexy while taking XYREM (old drug)

0

1

2

3

4

5

6

7

Cataplexy days on Xywav

(Skip if you don't have cataplexy) On average, how many days per week did you have episodes of cataplexy while taking XYWAV (new drug)

0

1

2

3

4

5

6

7