Treatment Center & Specialist Survey

Question Title

* 1. Please provide the contact information for your treatment center or facility. All fields must be completed to move on.

Name of hospital/medical center

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. How many Gaucher patients are treated at your facility?

10 or less

11-24

25-49

50-99

100 or more

Comments (optional)

Question Title

* 3. The majority of Gaucher patients treated at the center are

Infants

Children

Adolescents

Adults

Geriatrics

Question Title

* 4. Does your treatment center only offer infusions?

Yes

No