Mike's Heart Page

 

 

 

OHSU - Oregon Health Sciences University - Familial Dilated Cardiomyopathy Research Project - Ray E. Hershberger, M.D.

 

Congestive Heart Failure     Email Mike     Blog

Family History for OHSU Research Project:

In order to take part in this research project, a complete family history must be submitted, including contact information for further research.  The information you put in will only go directly to Mike and then to OHSU for the study.  For more information on privacy and on the study, please click here.

Biological Relationship to Mike:
First Name:
Middle Name:
Last Name:
Maiden Name:
Birthdate: MM/DD/YR  (7/9/51)
Alive?
Date of Death MM/DD/YR  (7/9/51)
Heart Problems?
Type of Problem:
Permission to contact?
Contact Information             Telephone: 
Address:
City:
State:
Zip Code:

Your Email:

Dad Mom   Greg Kathy Steve Jeff    Ed Roger    Evelyn Donald Laurie Judy Joan Ted

Jenny Brian Gary Grampa B Grandma B Grampa J Grandma J