Lipodystrophy (MR)

Lipodystrophy Respondents

We are a branch of a larger market research company, whose goal is to make contact with as many people diagnosed or involved in the treatment of Lipodystrophy. We will be looking to reach out to those interested in the form of online surveys and telephone discussions to further understand the needs of Lipodystrophy patients. When contacted and qualified we will pay respondents for their time (up to $100).

All information collected during the surveys or phone discussions will be completely confidential in that your name or any other identifying information will not be shown to our clients.

Question Title

* 1. Are you a diagnosed patient or caregiver of a diagnosed patient?

Patient

Caregiver

Question Title

* 2. How would you classify your (patient, if caregiver) lipodystrophy?

Congenital generalized lipodystrophy (Beradinelli-Seip syndrome, Brenzell syndrome)

Dunnigan’s or Kobberling familial partial lipodystrophy

Acquired generalized or partial lipodystrophy after juvenile or adult dermatomyositis or panniculitis or after viral infection

Localized Lipodystrophy due to insulin injections

HIV Associated Lipodystrophy

Other (please specify)

Question Title

* 3. Please provide contact information as noted (name, phone# requested - not required)

Name:

ZIP: *

Email Address: *

Phone Number: