General details

Just to help us identify where each questionnaire is from. All data is protected and will not be passed on to any other source

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* 1. What is your name

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* 2. What is your email address (optional, we will not pass on your email address but it would help contact you if anything of interest comes up on your form which may be of help to you) 

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* 3. What region or country do you live in

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* 4. How would you describe your current success at managing your Menieres symptoms

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