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Visual Snow Particpant Request for Next Study |
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Please email Prof, Goadsby and Dr. Schankin at?
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
with the following information. If you already sent a brief "I'm interested" email, please RESEND with this information. Thank you so much!
Name
Address
Date of Birth (Day/Month/Year)
Telephone number
Willingness to be contacted for research
Indicating they are allowing us to keep the contact details solely for communication for research? it?s a European data protection thing?
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Brief description of symptoms ? I know it is difficult but for an email yes or no to the other symptoms
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Short description of visual symptoms in own words:
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Visual snow: what type (chose one):
-????????? black and white (i.e. only black dots on white background, white dots on black background)
-????????? clear (i.e. color of the background)
-????????? flashing (i.e. always white, brighter than background)
-????????? colored
-????????? all of these
Other symptoms (yes or no)
-????????? After images
-????????? Trailing of images in the vision
-????????? Blue field entoptic phenomenon (i.e. white squiggly lines moving pulsating on the blue sky)
-????????? Floaters in vision
-????????? Colored clouds or waves with eyes closed
-????????? Flashes of light
-????????? Impaired night vision
-????????? Sensitive to? light
-????????? Tinnitus
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