Mind the Gap Question Title * 1. Are you interested in taking part in the Mind the Gap project? Yes No Maybe OK Question Title * 2. Address Name Company City/Town Country Email Address Phone Number OK Question Title * 3. Secretary Name OK Question Title * 4. Secretary Number OK Question Title * 5. Profession OK Question Title * 6. Are you happy to be contacted by us in relation to this project? Yes No OK Question Title * 7. Do you treat the following in your practice Hemifacial spasm Dystonia Spasticity Migraine Other (please specify) OK Question Title * 8. If you know, please tell us how many patients you treat on average: Per week OK Question Title * 9. If you know, how many patients are treated in your unit/service OK Question Title * 10. Please estimate the average interval (in weeks) between injection cycles for your patients. OK NEXT
