Teen Reply Form

I like your suggestion about (mark all you like):

telephone conference call
members-only internet chat room
members-only internet bulletin board
send questions in, answers appear in FAQ
more stuff on this homepage
frankly, I think all these suggestions are dumb
my own suggestions are much more brilliant (see
below)

I'd really like to see (write your brilliant suggestion(s) here):

How did you find this site?

My parents told me
Another relative told me
I saw your brochure
I found it through an internet search engine
A friend told me
A great green monster dragged me here
Other

If other, please tell us...

When you have questions about VHL, where do you find answers?

My parents answer my questions
My parents don't want to talk about it
My doctor or health care team answer my
questions
My school nurse answers my questions
I read the newsletter
I don't understand much of what's in the newsletter
I never see the newsletter
I look on the internet
I talk with my friends
I don't get answers, I just worry
I really don't think about it
Other

If other, please tell us where you go when you have questions

My biggest concern is

What else would you like to tell us, or ask us?

What's your real name, please?

What internet alias would you prefer to be known by?

What state or province or country are you from?

How old are you? (this is not a test, we're not restrictive, we'd really like to know - Thanks!)

What's your internet address? (this is optional, but if you want a direct answer to your question, we'll need this. Otherwise, your answer will appear in FAQ).

Please press the SUBMIT button to send this form.