Survey of ALS and Occupations

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This is an informal survey of PALS and their occupations.

  1. 1

    Please specify your current age by choosing one of the following groups.

  2. 2

    Approximately how long ago were you diagnosed with ALS?

  3. 3

    Was your ALS diagnosis classified as Familial or Sporadic?

  4. 4

    Place a check next to any/all of the following industries in which you worked. Please answer relative to past and/or present jobs held.

    Please select all that apply.

  5. 5

    What is your gender?

  6. 6

    Do you have Mercury fillings in your teeth?

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