Online submission form for the collection of Osteocondroma / Exostoses for Wim Wuyts, PH.D.
Department of Medical Genetics, University and University Hospital of Antwerp Belgium
Your Name:
Your Mailing Address:
Your Email Address:
Your Phone number:
                                   Date of birth:


                   Name of the participant:



Age of adult or child who is
participating in the collection of the
tumor samples for research project:

                         
                               Date of surgery:


Name of Hospital where the surgery
is taking place and physicians
name:



Number of surgeries you or the
child have had and location:




Is there a family history of MHE /
MO / HME.


Brief description of  surgery (for
example,  removal of exostoses
from wrist, etc.)















If the patient is a child, we will need
the  guardian and contact
information if this information is
different.






Have you or this child  participated
in a research project before, please
write the  date or year and project
information.







I have submitted the MHE Research
Registry Form.
Yes