Information on ClubFeet in Black and White

Survey about Club Feet and Club Foot

A question i have been asked many times, "I have Club Feet, does this mean my children will?"

I do not know the answer to this, I am researching the answer, and to help, I would like this survey completed.

With this survey, I can see if there is a pattern at all. This will only work with your help, please complete the survey, it will only take 2 minutes.

The information you provide to me will not be sold or mis-used in any way. Only I will see your name and email address, If you do not want to give these details, don't worry, just make up a name, or use anom.



Please help me by taking part in the short survey. All of the fields are optional.

(1) Name:
 
(2) Email Address:
 
(3) Your Age
 
(4) Your Location
 
(5a) I have..:
(5b) If Other, Please State:
(5c) Do you still suffer from Club Feet/Foot?:
 
(6a) My Mum has:
(6b) If Other, Please state
(6c) Does your Mum still suffer with Club Feet?:
 
(7a) My Dad has:
(7b) If Other, Please state
(7c) Does your Dad still suffer with Club Feet?:
 
(8a) My grandad has:
(8b) If Other, Please state
(8c) Does your Grandad still suffer with Club Feet?:
(8d) On what side of the family?:
 
(9a) My Nan has:
(9b) If Other, Please state
(9c) Does your Nan still suffer with Club Feet?:
(9d) On what side of the family?:
 
(10a) My child/children:
(10b) How many children do you have with Club Feet?:
(10c) How many children do you have with CLub Foot?:
(10d) How many children do you have in total:?
 
(11) What treatments have you or your child had:?



 
(12)Any other information you might like to give:
 
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