Normal Pressure Hydrocephalus

Hispanic or Latino/a (A person of Mexican, Puerto Rican, Cuban, Central or South American, Iberian Peninsula, or other Spanish culture or origin, regardless of race) Not Hispanic or Latino/a (A person not meeting the definition for Hispanic or Latino) Refused

Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam) American Indian or Alaska Native American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment) Native Hawaiian or Other Pacific Islander (Denotes a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. The term covers particularly people who identify themselves as part-Hawaiian, Native Hawaiian, Guamanian or Chamorro, Carolinian, Samoan, Chuu) African-American or Black (A person having origins in any of the black racial groups of Africa. Terms such as Haitian can be used in addition to African American) White or Caucasian (Denotes a person with European, Middle Eastern, or North African ancestral origin who identifies as White) Refused

Right handed Left handed Ambidextrous

Yes No

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Yes No

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Yes No

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