Join HMDSN

It would be nice if you could enter the following information. As Spam emailers are attacking us then more information is now asked. All information is held in the strictest confidence. It is just to give us some idea of the reason that you want to join the group so that we maybe able to help you better.

All items marked with an '*' must be input

Please pick whick category you fall into and therefor which group you wish to join;* Parent with a Child having problems Adult with problems
Your Name: *		Child´s Name: *
		Date of Birth * Day Month Year
Address:*		Main Hospital Treated at ?: *
Email Address: *		Country: *

What Type of Motility problem does your child have? *

If your child has Hirschsprung's (HD), what type is it?

Describe What Type of HD or other Motility Problem: (*)	Any other relevent Information?: