The code block below illustrates how one might use # and // as comments in your logic and calculations.

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This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

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The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

njZFmmkd2Rmrm7RAxjFXoJU

ALD National Registry Initial Survey

Thank you for your interest in the ALD National Registry at the University of Minnesota.

The survey questions below are designed to help us collect basic contact information and to confirm your interest in the ALD National Registry

Once you complete and submit the survey, the approrpriate clinical and/or research coordinators will be notified. You must complete all questions of the survey and click "Submit" in order for our staff to be notified!

Would you like to be contacted about participating in the Adrenoleukodystrophy (ALD) National Registry study?

* must provide value

Yes

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Are you filling this survey out on behalf of yourself or your child?

* must provide value

Self

Child

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How did you hear about this registry?

* must provide value

Social Media

Advocacy Group

Healthcare Provider

Other study participant

Other

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Describe "Other"

First Name

* must provide value

Last Name

* must provide value

Please enter your email address.

* must provide value

Please enter your phone number.

* must provide value

Child's First Name

* must provide value

Child's Last Name

* must provide value

Please enter the child's parent/guardian email address.

* must provide value

Please enter the child's parent/guardian phone number.

* must provide value

What is your preferred method of communication?

* must provide value

Phone

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Have you received a hematopoietic stem cell transplant or gene therapy for treatment of ALD?

* must provide value

Yes

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Has your child received a hematopoietic cell transplant or gene therapy for treatment of ALD?

* must provide value

Yes

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Unfortunately you are not eligible for this study. Please complete the survey by clicking the "submit" button so that we are aware of this. Record any questions in the comments section below and we will reach out to you to answer them.

Unfortunately your child is not eligible for this study. Please complete the survey by clicking the "submit" button so that we are aware of this. Record any questions in the comments section below and we will reach out to you to answer them.

Thank you for taking the time to complete our survey. Please let us know if you have any additional comments. If you expressed interest in the study, someone from our team will reach out to you soon to discuss the registry study.

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.