Contact Registry PCD Foundation Patient Contact Registry Question Title * 1. Name: First Name: Last Name: Question Title * 2. Check one of the following Adult (Over 18 years of age) Pediatric (Birth - 17 years old) Question Title * 3. Location State/Province ZIP/Postal Code Country Question Title * 4. Date of Birth Date Information Date Question Title * 5. Gender Male Female Question Title * 6. Has your PCD diagnosis been confirmed? Yes No Pending Confirmation Unsure Question Title * 7. If yes, how was your diagnosis confirmed. Clinical Consultation Genetics Nasal Nitric Oxide (nNO) Electron Microscopy (EM) Waiting for confirmation Not confirmed Question Title * 8. Are you followed at an accredited PCD center? Yes No If yes, which center? Question Title * 9. Are you satisfied with your current treatment options for PCD? Yes No Done
