1.Please select which statement(s) best reflect your experience:

I am a person born with a limb difference

I am a person who has experienced limb loss and / or identifies as an Amputee

I support / know a person born with a limb difference

I support / know a person who has experienced limb loss and / or identifies as an Amputee

2.Please select which statement(s) best reflect your relationship / connection to a person living with a limb difference:

Parent

Self

Spouse / Partner

Child

Sibling

Friend

Coworker / Colleague / Classmate

Extended Relative (In-Laws, Grandparent, Cousin, Aunt / Uncle, Niece / Nephew, etc.)

Relationship Not Listed (Please Describe):

3.Age Demographics

0 - 17 Years

18 - 29 Years

30 - 39 Years

40 - 49 Years

50 - 59 Years

60 Years and Better

4.What's the biggest concern and / or challenge you have right now as it relates to your limb difference life? **This applies to individuals living with limb difference and / or someone who knows or supports a person living with a limb difference.

5.What's the biggest result and/ or improvement you want to see as it relates to your limb difference life? **This includes individuals living with limb difference and / or someone who knows or supporting a person living with a limb difference.