RRP Form – Welcome

(copy) first? have

How many years have you been in practice?

Fellowship or first year of practice
2-5 years
5-10 years
>10 years

Did you complete a pediatric otolaryngology fellowship?

Yes
No

Did you complete a laryngology fellowship?

Yes
No

Do you have a laryngology focus in your practice?

Yes
No

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit:

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #2

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #3

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #4

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #5

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #6

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #7

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #8

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #9

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #10

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #11

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #12

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Please check any adjuvant and other treatments for RRP you have used in the past 5 years, and whether you found benefit: #13

Check if used

Benefit

Checkboxes (copy)

Intralesional cidofovir

Checkboxes (copy) (copy)

Intralesional bevacizumab

Field #33 (copy)

Field #33 (copy) (copy)

Checkboxes (copy) (copy)

Intralesional cidofovir

Field #33 (copy) (copy) (copy)

Checkboxes (copy) (copy) (copy)

Intralesional bevacizumab

Field #33 (copy) (copy) (copy) (copy)

Checkboxes (copy) (copy) (copy)

Systemic bevacizumab

Field #33 (copy) (copy) (copy) (copy) (copy)

Which of these adjuvants do you typically add first?