Name *

Only first name will be shared

First Name

Last Name

Which mutation do you/ your family member(s) have? *

COL4A1

COL4A2

Other community members may find similarities to your answers and have a desire to connect with you/your family. If you are open to being contacted by fellow Gould Syndrome individuals or families? *

Contact requests will be sent through the Gould Syndrome Foundation website and a member of the foundation will reach out to you.

Yes

No