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VBF IMD questionnaire

VBF IMD Questionnaire

This is a 5 minute questionnaire about the use of infant monitoring devices for patients with facial port- wine birthmarks. By filling out this questionnaire, you consent to this information being utilized by the Vascular Birthmark Foundation (VBF) for research and education. Your child’s data will be de-identified and may be analyzed to better understand this topic. This questionnaire is voluntary. You may also stop the survey at any time after beginning. If you have any questions, please reach out to Dr. Linda Rozell-Shannon: vbfpresident@gmail.com
1.Who is filling this survey out on behalf of a child with SWS
2.Patient's Sex
3.Patient's Ethnicity
4.Patient's Race (select all that apply)