Externally Led Patient Focused Drug Development Meeting: Speaker Questionnaire* 

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Speaker Demographic Information 
* The official speaker submission window has closed. Interested participants may still complete a form to be considered as a back up presenter or a live call in speaker for the meeting on October 29th.  

** The Patient Focused Drug Development initiative aims to obtain the patient perceptive on specific diseases and their treatments. Please complete this questionnaire as it relates to the patient. Each section should be filled out from the perspective of the patient or the caregiver as indicated.

***Please fill out one form per patient. If you have more than one patient story to share please fill out multiple forms. 















Patient Demographic Information 










Patient Impact: Please complete from patient perspective (you) or from the Caregiver perspective ( your loved one).
  












Caregiver Impact (Please complete only if you are a Caregiver of a patient with Krabbe disease) 







Patient Care: If your loved one is deceased please respond based on the care that was provided  to help them live their best life 











Meeting Participation