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MS Study
Information confidential for Bradenton Research Center only.
Who are you taking this questionnaire for?
Myself
My Relative
My Partner
Someone I care For
Someone Else
Are you between the age of 18-65?
Yes
No
When were you first diagnosed with MS?
Which best describes how far you can walk:
0 ft
25 ft
50 ft
100 ft
200+ ft
First Name
Phone Number
Submit The Inquiry
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