Survey

My name is Evelyn and I am conducting a survey for my Science Research project. I am a junior in high school and hope to educate more people about chronic disease through my research. I chose this topic because my mother passed away from scleroderma in 2003.

For my research project, I need to include two surveys that require general health information from individuals with scleroderma. The first survey will ask you about your physical state and ability to function in daily activities. The second survey will ask about your mental state. The survey is voluntary and can be stopped at anytime. Your answers will be completely anonymous. The answers will be sent to me. The results will be kept in a secure location and used only for analytical purposes.

My research advisor is Dr. Ann Impens, a research investigator with the Scleroderma Program at the University of Michigan. The contact information of Dr. Impens is below. If you have any questions or concerns about this survey, please contact Dr. Impens for further assistance at:

Contact Information:
Dr. Ann Impens
aimpens@med.umich.edu
University of Michigan Scleroderma Program
Domino's Farms
24 Frank Lloyd Wright Drive
P.O. Box 481, Lobby M,
Suite 2500
Ann Arbor, MI 48106
Office Phone: 734-763-3110
Toll-Free: 866-628-9200
Fax: 734-763-5761

Click here to start pre-survey.

Scleroderma Foundation
300 Rosewood Drive, Suite 105, Danvers, MA 01923
Phone 978-463-5843 · Fax 978-463-5809 · 800-722-HOPE (4673)
Email: sfinfo@scleroderma.org. Web site: www.scleroderma.org