Information . . .

Qualifications . . .

Your response and contact information will be held in the strictest confidence. Please abide by all the following criteria:

Reporting Your Experience

Your confidentiality is strictly protected, but we must have contact and demographic information for the ethical conduct of our research.  The contact information you submit will only be used for verification and to enable us to obtain your permission to use the records you send to us.  It is possible we may want to ask follow-up questions to clarify aspects of your experience, but Dr. Wade is the only person who will have access to your contact information and your record both.  Your data will be downloaded, and with your permission, assigned a code-name to protect your anonymity, and separated from your contact information in our files.

If you have had an experience you would like to tell us about for our ongoing research, please use the spaces below.  Please complete the name and address fields so that I can follow up with you for permission to use your data, if necessary.  Describe your experience(s) in the box marked “Comments” which will expand to hold as much information as you would like to transmit.

Send Dr. Wade Your Experience . . .

First Name
Last Name
Address Line 1
Address Line 2
Zip Code
E-mail Address