• Contact Relationship to patient
• If other, please specify
• 23. In what year were you born?
• If other, please specify
• 28. What is the primary language used in your home?
• If other, please specify
• 29. Is a second language used in your home?
• If yes, what is the second language?
• If other, please specify
• 30. How many other children do you have?
• 31. Apart from having your baby screened through this program, is there anyone in your family who has/had Duchenne?
• If other, please specify
• 1. What is today's date?
• Premature infant
• 4. Did your baby spend any time in the neonatal intensive care unit (NICU)?
• Relationship to patient Family member
• If other, please specify
• 6. In what year were you born?
• Marital status
• If other, please specify