OTSEGO AREA HEALTH SURVEY 2018 otsegohealthsurvey@gmail.com

This survey was produced with the intention of gathering medical history and conditions of the people that resided in or currently reside in the Otsego/Plainwell area. The primary goal of this survey is to take record and account of all diseases and conditions that may have been related by the Kalamazoo River PCB contamination. It is not intended to treat, diagnose, or provide an official correlation to river exposure. Members of the community are interested in the potential for more research looking into the long term effects of PCB exposure and this survey will aid in getting attention from local agencies. Please note that all information will be confidential and only stats may be shared (no identifiable information) to the Otsego Community. If you have no problem sharing your Name and Contact information to the intended recipients (Dept. of  Health, ATSDR, EPA Toxicologists) Please do so in the comments section.  

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* 1. Your health concern relates to:

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* 2. Please list the name of your diagnosis:

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* 3. What is your gender

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* 4. What was your age at diagnosis

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* 5. What year did you graduate from high school?

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* 6. Do you have a family history of cancer or other diseases related to your condition?

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* 7. Did your parents grow up in Otsego?

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* 8. Please provide some additional information on the address or areas where you lived/grew up in Otsego

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* 9. Did you participate in any of the activities below on a regular basis?  Check all that apply

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* 10. Please provide any additional feedback or comments & contact info here optional:

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