Contact Us

* indicates a required field.

Contact Information

Birth Date *

Gender *
Do you believe you have problems with face recognition? *

Do you believe that your family members have problems with face recognition? *


Face Recognition Information

If you are writing long responses, you may want to write your responses in a seperate word document on your computer and paste them into this webpage. This will prevent you from accidentally losing all of your typed responses if something goes wrong with your browser or the webpage.










May we contact you? *