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Center for Health Sciences
Morgellons Disease
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What, Who, Where, When, Why, and How
Vision and Goals
Our Research
What You Can Do
Secure Registration
Links and Resources (including MP3 audio interview w/ Dr. Wymore)

Registration Form

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Phone Number
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Who are you? (check all that apply)

Patient Doctor/Health Professional Researcher Donor Family/Friend Press

If you are a patient:

Symptoms: (check all that apply)

Lesions or sores
Fibers or filaments on skin
Itching or stinging
Hair loss
Joint pain
Granules or specks on the skin
Biting or crawling feeling on the skin
Mood disorder
Memory or concentration problems
(ex: 'brainfog', short term memory loss)
Vision problems
Edema or swelling

Diagnosis by a physician: (check all that apply)

Occupation at onset of symptoms

Are you the only one in your family with Morgellons or are there others?

If there are others,how many?

Their relationship to you

Additional medical conditions

If you are a Doctor or Health Professional

Professional Affiliation

Clinical experience, if any, with Morgellons

I would like to help, please contact me.

If you are a Researcher

Professional Affiliation

Area of Research

Research interest in Morgellons

I would like to help, please contact me.

If you are a Donor

Have you donated to Morgellons yet?

If yes, where?

Click here to contribute to OSU Research on Morgellons

If you are family or friend of a Morgellons patient

Relationship to the patient

I would like to help, please contact me.

If you are with the Press

What news/press organization are you with?

I am interested in:
Writing a story for a magazine or newspaper
Creating an online blog or news article

How would you like to be contacted?



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