Our industry partners frequently ask our caregivers to participate in surveys an/or patient steering committees. This allows them an opportunity to establish and develop strong relationships with community stakeholders and simultaneously collect critical feedback to inform the creation and implementation of pragmatic solutions for everyday needs and challenges faced by the community. 

If you are interested in participating in future surveys and/or a patient steering committee led by an industry partner, please complete this survey. Should opportunities arise, you will be contacted by DSF. You are under no obligation to participate in any opportunity presented to you. At no time will your personal information be shared with an industry partner without your permission. There is typically compensation and/or travel reimbursement depending on the opportunity.

For questions, please contact: maryanne@dravetfoundation.org.

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* 1. Your name

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* 2. Email address

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* 3. City & State where you currently reside (open to US Families only at this time)

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* 4. Your child's first name

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* 5. Your child's birthdate

Birthdate

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* 6. Your child's gender

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* 7. Your child's diagnosis

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* 8. Your child's ethnicity (this is important to assure that we have the diversity of our community properly represented in these surveys and committees).

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* 9. Please select all opportunities that you would be interested in potentially participating in.

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* 10. Comments 

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