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Visual Snow Particpant Request for Next Study PDF Print E-mail
Please email Prof, Goadsby and Dr. Schankin at? This e-mail address is being protected from spambots. You need JavaScript enabled to view it with the following information. If you already sent a brief "I'm interested" email, please RESEND with this information. Thank you so much!



Date of Birth (Day/Month/Year)

Telephone number

Willingness to be contacted for research

Indicating they are allowing us to keep the contact details solely for communication for research? it?s a European data protection thing?


Brief description of symptoms ? I know it is difficult but for an email yes or no to the other symptoms


Short description of visual symptoms in own words:


Visual snow: what type (chose one):

-????????? black and white (i.e. only black dots on white background, white dots on black background)

-????????? clear (i.e. color of the background)

-????????? flashing (i.e. always white, brighter than background)

-????????? colored

-????????? all of these

Other symptoms (yes or no)

-????????? After images

-????????? Trailing of images in the vision

-????????? Blue field entoptic phenomenon (i.e. white squiggly lines moving pulsating on the blue sky)

-????????? Floaters in vision

-????????? Colored clouds or waves with eyes closed

-????????? Flashes of light

-????????? Impaired night vision

-????????? Sensitive to? light

-????????? Tinnitus