| | Question | Response choices |
| (i) Have you ever used any of the following for your health?
(a) If yes, have you used (CAM modality) in the last month?
Listed options: acupuncture, ayurveda, biofeedback, chelation therapy, and chiropractic care or chiropractor, energy healing therapy or reiki, and folk medicine such as curanderismo or native American healing, hypnosis, massage, and naturopathy | No, yes, do not know
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| (i) Have you ever used natural herbs or dietary supplements for your health? For example ginger, Echinacea, or black cohosh
(ii) Have you used natural herbs or dietary supplements in the last month? | No, yes
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| (i) Have you ever used any of the following mind-body techniques for your health?
(a) If yes, did you use (CAM modality) in the last month?
Listed options: meditation, guided imagery, progressive relaxation, deep breathing exercises, Yoga, tai Chi andqigong | No, yes, Do not know
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| | (i) Using a scale from 0 to 10 (where 0 is not at all important and 10 is extremely important) in your opinion, how important are mind-body interactions to your health? | 0–10 Likert scale |
| | (i) Would you be interested in learning mind-body techniques at no cost to you? | No, yes |
| (i) If respondent stated no: Why are you not interested in learning mind-body techniques?
Listed options: i am not interested, mind-body techniques do not work, i do not have time, i won’t be able to learn, i donot have the energy, i am too sick, i donot have the money, i do not have a place to learn, and other | Mark one or more categories |
| | (i) If your doctor agreed, would you be interested in a study that would teach you mind-body techniques that you would practice during dialysis? | No, yes
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