Questionaire	Jack O'Donnell
	Apr 29, 2001 16:27 PDT

In an attempt to get a better feel for the group history, it would be appreciated if you would take a few minutes to complete and return the following questionaire.

1.   YEAR OF BIRTH:
     (Year of birth will be kept by me only and will be used for calculation purposes, NO individual age or year of birth will be shared or revealed.)

2.   HFS SIDE:                                                                            RIGHT   LEFT

3.   APPROX. AGE WHEN HFS STARTED:
      (See comment for # 1.)

4.   APPROX. YEAR HFS STARTED:

5.   EVER RECEIVED BOTOX:                                                       YES    NO

6.   IF YES, STILL RECEIVING:                                                     YES    NO

7.   HAVE YOU HAD AN MVD:                                                       YES    NO

8.   IF YES, HOW MANY:                                                               1   2   3   4

9.   IF YES, BY WHOM, WHERE, AND WHEN (MONTH/YEAR):

10. IF YES, ARE YOU NOW SPASM FREE:                                     YES   NO

11. IF YES, ANY PERMANENT COMPLICATIONS:

Please send responses to my attention at the email address below, not as a post to the group.

Thanks in advance for your cooperation and assistance.

Jack O'Donnell
Warminster, PA
jj-@home.com