Your contact details

Thank you for your interest in hearing more about our studies which evaluate wrist/hand orthoses (splints) for children with cerebral palsy.
Please complete all the questions below to allow us to make contact with you. 

* 1. Your name?

* 2. Your child's name?

* 3. Your child's date of birth?

Date
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* 4. Your email address?

* 5. Your home phone number?

* 6. Your mobile phone number?

* 7. Your address

* 8. Is your child a client of Cerebral Palsy Alliance?

* 9. Which Cerebral Palsy Alliance site do you attend?

Thank you!
We look forward to making contact with you in the next 2 weeks.
Please click the Finish button below

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