Cure SMA Community Update Survey Request Form

Cure SMA Community Update Survey Request Form

Since 2017, Cure SMA has been hosting an annual Community Update Survey to collect information from the Cure SMA community to better understand the evolving landscape and unmet needs of the SMA community. If you have not received an email from Cure SMA inviting you to participate in this year's survey, please complete the following form to request a survey link. Please note that the Community Update Survey is open to U.S. participants only.

Please allow 72 business hours for your request to be processed.

1. Contact Information *This question is required.

First Name

Last Name

Street Address

City

Zip

Country

Email Address

Phone Number

2. Relationship to Person with SMA. Please note only primary caregivers and adults living with SMA are able to participate in the annual Community Update Survey. *This question is required.

What is the affected individual's first name?

What is the affected individual's last name?

What type of SMA does your child have?

What type of SMA does you have?

What type of SMA do they have?

When is your child's birthdate? This question requires a valid date format of MM/DD/YYYY.

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When is your birthdate? This question requires a valid date format of MM/DD/YYYY.

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When is the affected individual's birthdate? This question requires a valid date format of MM/DD/YYYY.

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In what year was your child diagnosed with SMA? Please provide your answer as a 4 digit year (YYYY)
This question requires a valid number format.

In what year were you diagnosed with SMA? Please provide your answer as a 4 digit year (YYYY)
This question requires a valid number format.

In what year was the affected individual diagnosed with SMA? Please provide your answer as a 4 digit year (YYYY)
This question requires a valid number format.