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Gastrostomy survey

Hello, thank you for your interest in taking part in our research project. The project aims to collect data to guide clinical practice in the management of swallowing problems in MSA and other atypical parkinsonian conditions.  

Thank you for taking the time to complete our survey. 
1.What is your current diagnosis?(Required.)
2.Has a Gastrostomy/PEG/Feeding Tube been recommended to you?(Required.)
3.If yes, when was it recommended? (Please provide a date in the format DD/MM/YYYY) If no, please write N/A.(Required.)
4.Do you currently have a Gastrostomy/PEG/Feeding Tube?(Required.)
5.If yes, when was it inserted? (Please provide a date in the format DD/MM/YYYY) If no, please write N/A.(Required.)
6.Would you like to be contacted to participate in a research project on the management of swallowing problems and PEG in MSA?(Required.)
If you answered yes to question 6, please complete questions 7-9.
7.Please provide your full name:
8.Please provide the best telephone number to contact you on:
9.Please provide your email address: