The following requests require your name, address, phone number and email.

*Phone:
*Email:
Code:
*Code:	Please copy the code here

If you need further assistance, please contact the NGF at 800-504-3189
or email us at ngf@gaucherdisease.org

The following survey is completely voluntary, but can help to benefit both you and the NGF.
Please take a moment to complete and submit them to the National Gaucher Foundation.
We appreciate your assistance in helping us to better serve you.

• Prior to visiting our website, had you ever heard of Gaucher disease? Yes No

• If yes, how:

• Do you have symptoms of Gaucher disease? Yes No

• If yes, please check all that apply:

• Have you or a family member been tested for Gaucher disease? Yes No

• Has your physician indicated that you or a family member is a carrier of the Gaucher gene? Yes No

• Does Gaucher disease run in your family? Yes No Don't know

• Have you or a family member been diagnosed with Gaucher disease? Yes No

• If yes, are you/family member currently on treatment? Yes No

• What form of Gaucher are you/family member being treated for?
Type 1 Type 2 Type 3

• What is your age group? 13-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

• What is your gender? Female Male

• Email address:

• Code:

• Copy code here:

Thank you for completing this survey

If you need further assistance, please contact the NGF at 800-504-3189
or email us at ngf@gaucherdisease.org

The following survey is completely voluntary, but can help to benefit both you and the NGF.
Please take a moment to complete and submit them to the National Gaucher Foundation.
We appreciate your assistance in helping us to better serve you.

• How did you hear about the National Gaucher Foundation?

• What brought you to our website?

•Did you find this website helpful? Yes No

•What other information would you like to see at our website?

• What is your age group? 13-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

• What is your gender? Female Male

• Email address:

• Code:

• Copy code here:

Thank you for completing this survey

If you need further assistance, please contact the NGF at 800-504-3189
or email us at ngf@gaucherdisease.org