Cortica Phelan-McDermid Syndrome Research Interest Form
Gender:
Female
Male
Non-Binary
Sex:
Female
Male
Intersex
This study is recruiting patients nationwide. Please select the California site you would prefer to visit (travel expenses are reimbursed).
San Rafael, California (Northern California)
Glendale, California (Southern California)
Interested in either location
Has your child had any seizures within the past 6 months or more than 1 seizure within the past 12 months?
Yes
No
Does your child have any additional medical, development, or mental health diagnoses? If yes, please list confirmed diagnoses below.
Please initial below to be contacted regarding your specified interest. https://www.corticacare.com/privacy-policy
