Survey

User data submitted here are used specifically to raise awareness among doctors about Empty Nose Syndrome and to help promote research in finding a cure for ENS. We will also keep you updated through our community mailing list if and when something important arises so enter your active e-mail address. Please answer the following questions as accurately as possible in order for us to gather a good pool of data to be used for our vital cause.

First Name

Last Name

Gender

Age

E-mail Address

Country

State/Province

City

Street Address

Zipcode/Postal Code

Phone Number

Do you suffer from ENS (or Secondary Atrophic Rhinitis)? If so, please state how long you have you been suffering from ENS (or Secondary Atrophic Rhinitis) and describe in detail the symptoms that effect you.

What kind of operation/s did you have, and please specify the amount of turbinates, or other nasal structures, which were removed from your nose.

Have you had any reconstructive surgeries since you have developed ENS (or Atrophic Rhinitis)? If so, please describe in detail.

Would you like to volunteer and help promote the goals of this website? If so, please describe how you can help. (financial, legal issues, website, etc.)

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