Submit Angelman Syndrome Sleep Medication Survey

IMPORTANT: This survey does not collect any identifiable information.
Please do NOT enter any details such as names or locations.
This data is meant to be 100% anonymous for the general Angelman Syndrome community.
This is NOT a scientific survey and is for information only.

*Your angels' age
(Or age at which they stopped using sleep meds)
*Your angels' gender Male Female
*Your angels' diagnosis Clinical
Deletion posistive (DEL+)
Imprinting defect
Mosaicism
UBE3A
UPD (Uniparental disomy)
*Medication 1 for sleeping
(Brand and/or generic name)
*Dosage 1
Include mg/dose + whether just before bed,
in conjunction with other meds or relevant comment
Medication 2 for sleeping
(Brand and/or generic name)
Dosage 2
Include mg/dose + whether just before bed,
in conjunction with other meds or relevant comment
Other sleep medication comments
DO NOT INCLUDE IDENTIFYING INFORMATION
(I.e. do not enter your angels' name, doctors' name or your location)
To keep survey results consistent, fields with a red asterisk, *, are required

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© 2017 Marc Bissonnette / Internalysis