DES Action USA has developed a new brochure encouraging DES Grandchildren to keep alert for new information about DES. This brochure outlines research so far in the field of third generation DES exposure and is designed to help DES Grandchildren think about DES as part of their health histories. As a good forward-thinking initiative, this brochure flies in the face of Australia’s drastic need for improvement in keeping DES mothers and their children informed. To view the brochure, visit the web site www.desaction.org and click the link for DES Grandchild.
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DES GRANDCHILD QUESTIONNAIRE
Researchers look for anecdotal information to guide them to areas of study. They often ask DES Action USA about the types of health problems we hear of in the DES community. If you would like to help, please fill out this questionnaire and return it to DES Action USA, 187 via Catalunha Jupiter, FL 33458 USA. If you have questions please call USA (008)337-9288 or email info@desaction.org Your contact information will be kept confidential. Thank you for taking the time to fill out and send this form to DES Action USA about your family health history.
TODAY'S DATE..........................
INFORMATION ABOUT THE DES DAUGHTER OR SON
Year of Birth.........................
DES-related health concerns (like cancers, endometriosis, & age at onset if known).......................................
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Pregnancy year and outcomes (such as ectopic, miscarriage, preterm, etc)
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INFORMATION ABOUT DES GRANDCHILDREN & GREAT GRANDCHILDREN
Please give birth year, indicate male or female, grandchild or great grandchild, and describe health for each, including year of onset.
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(Use another page if required.)
Optional: Your name and contact information:
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