If you choose to remain anonymous, please put your favourite colour as your first name and favourite food as your last name instead (e.g Pink Mango, Blue Pancakes, Green spaghetti, ect) *

First Name

Last Name

Have you experienced visual snow symptoms?

Yes and I am currently experiencing symptoms!

No and never have!

I have in the past but not recently.

Not me but I know some one who experience symptoms.

I'm not sure.