Cortica Phelan-McDermid Syndrome Research Interest Form

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.

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