Please select the type of service you would like:

Level 1 Service (free)

Level 2 Service (fee-based)

Your name:

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Telephone (include area code):

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Today's date (dd/mm/yyyy):

1) What is the subject of your search? Please be as specific as possible.

2) What type of information are you seeking?

A general overview

A specific aspect of the topic, such as symptoms, diagnosis, treatment , complications, etc. Please explain:

local support groups, national organizations, hotlines

3) Information is sent from our consumer health collection of materials written for the layperson. Occassionally material written for the layperson is not available. In that case would you like technical medical information sent instead?

yes no

4) To reduce duplication of effort, please tell us what information (titles, periodicals etc) that you have already found). Title and author information is sufficient.