FORMING AN ADHESIONS SUPPORT GROUP

ARE YOU INTERESTED IN FORMING AN ADHESIONS SUPPORT GROUP?

I would be interested to hear from anyone interested in forming such a group. I am particularly interested to hear from anyone in Dallas who would have the time and ability to help with the administrative tasks of such an organization.

Please fill out the following form:

Name
Email Address
Address
Phone
Fax
Male/Female
Brief description of your adhesions problem

Do you have any special skills/experience that may be useful in running a patient support group? yes no Explain: I would be interested in being contacted regarding clinical trials relating to my condition yes no I would be interested in receiving other information relating to my condition yes no
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