1. Consent to Survey

50% of survey complete.

The purpose of this research project is to investigate the relationship between brain changes and genetic risk factors in patients with and without family history of spasmodic dystonia. This research project is being conducted by Dr. Kristina Simonyan and her research team at the Mount Sinai Hospital in New York City.

Your participation in this research study is voluntary. You may choose not to participate. If you decide to participate in this research survey, you may withdraw at any time.

You are invited to participate in this study if you either have spasmodic dysphonia or are a healthy research volunteer. To gain preliminary information about whether you may qualify for the study participation, we ask you to complete this online survey, which will take approximately 5-10 minutes of your time. Your responses will give us an overall idea about your eligibility. At the end of the survey, if you are interested in the study participation, please either call us back at the number provided or provide your contact information so we may get in touch with you to explain the study procedures in greater detail.

We will do our best to keep your information confidential. All your responses will be transmitted to us via the SSL encrypted website. Received information will be stored in a password-protected electronic format. To help protect your confidentiality, the surveys may contain only minimal information (such as the first name and telephone number) that may personally identify you. The results of this survey will be used for research purposes only and will not be shared with anyone outside of our research team.

If you have any particular questions about the research study before completing the survey, please contact us by telephone (212) 241-8729 or email: dystonia.research@gmail.com

This research has been reviewed according to the procedures of the Institutional Review Board (IRB) of Mount Sinai School of Medicine for research involving human subjects.

ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "I AGREE" button below indicates that:
• You have read the above information and agree to the terms and conditions
• You voluntarily agree to participate in the survey
• You will complete the survey according to the best of your knowledge
• You are at least 18 years of age

NOTE: Please do not select "I AGREE" if you do not intent to participate in the survey as it will generate an 'empty' report. For general information about the study, please contact us at dystonia.research@gmail.com or (212) 241-8729.

Clicking on the "I DISAGREE" button below indicates that:
• You have read the above information and do not agree to the terms and conditions
• You do not agree to participate in the survey

* 1. Please select