Directions

This survey is to be answered by or about a single individual who has been diagnosed or told they have FSH muscular dystrophy. (A parent, guardian, or caregiver can respond on behalf of an affected individual. Please answer the questions as if you are the patient.) Your responses are confidential. Responses are tied to a specific IP address. If you have other family members who also have FSHD, please feel free to forward them the email with the link to this survey. 

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* 1. Are you (check all that apply):

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* 2. Where is your primary residence?

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* 3. What is your (i.e. the patient’s) age?

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* 4. Do you (i.e. the patient) identify as

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* 5. What is your (i.e. the patient’s) race/ethnicity? Check all that apply and include countries of origin in the text box.

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