Growing Connections GHD Video Participant Survey

Thank you for your interest in this patient support program with MAGIC Foundation, sponsored by Pfizer. Our goal is to provide support to families new to, or currently using, growth hormone treatment via real-life stories, experiences, and advice.

If selected, you, your child, or another family member will tell their story using a smartphone or tablet to create a short video. To begin the process, please complete the form below.

This information will not be used in any way outside of this purpose.

This questionnaire will be used for GHD caregivers to sign up to participate in this unbranded program (share their experiences with Growth Hormone Deficiency as part of the unbranded Growing Connections program). This information will not be used in any way outside of this purpose.

For background, Growing Connections is an unbranded Peer-to-Peer program being created in partnership with The MAGIC Foundation and will provide a holistic support system to newly diagnosed patients with a focus on emotional and social resources to navigate the journey. Please note this will be an ongoing program – not all participation requests will be granted immediately, however we hope to have all that want to participate involved during this program’s lifespan.

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* 1. Parent/guardian full name

First name

Last name

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* 2. Parent/guardian email

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* 3. Parent/guardian phone

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* 4. Parent/guardian full address

Street Address

City

State

Zip code

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* 5. Primary language spoken at home

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* 6. Do you or your child speak any other languages fluently?

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* 7. Child’s age

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* 8. Child’s age at growth hormone deficiency diagnosis

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* 9. How long did it take to get diagnosed?

A few weeks

3-6 months

7-12 months

Over a year

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* 10. How long has your child been on GH treatment?

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* 11. Who is interested in providing their experiences via video (select all that apply):

Myself (parent/guardian)

Other parent/guardian

My child

Sibling

Other (please specify)

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* 12. What has been the largest roadblock you have had to overcome in regard to your child’s GH treatment?

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* 13. What do you wish you could tell new families just starting GH treatment?

Thank you for your interest in participating in the Growing Connections program.

On behalf of Pfizer and MAGIC Foundation, a Rarity Health representative will reach out to you regarding next steps.

If you know of another GHD family who may want to participate in this program, please share this link: www.myGHDstory.com