Zap•Life
Submission Form Selector

Thanks so much for taking the time to make a contribution to our goal to publish a book (working title: Zap•Life)to help people deal with Implanted Cardioverter Defibrillators. We want this to help friends, family members, and (professional) care givers... as well as those of us with an ICD inside us. That's why we provide the opportunity to provide comments for the benefits of others.
Taking time to fully answer every question could take an hour, for which we would we very pleased... if you have the time. Skip any item which is either not applicable to your situation or too uncomfortable to address. To make it worthwhile, we will send you a free copy of the book when it is published.
Some questions designed only to harvest survey data will be completely disconnected from the identities of those submitting this form. So don't worry about offending someone or getting in trouble.... answer as honestly and completely as you can.
Thanks again for your effort.
Jon Duffey
One Tip for you all when you go to fill in the form that you select below, when you have the form on your screen go of line and then when you submit it the computer will go on line again for you as the forms take time to fill in and we thank you for the time that you send to fill it in and when you submit it the form will go to the States.
Select the Proper Submission Form:
ICD
Recipient
Family Member
or Friend
Health Care
Professional
HHM
Copyright © 1999 by The CK Trust Fund
Duplication/distribution encouraged - with attribution.