01. Name or Preferred Name

02. Email

03. State

04. City

05. Telephone

06. Date of birth

07. Gender
MaleFemaleTrans (or non-binary)

08. Are you a person living or coexisting with Leber’s Hereditary Optic Neuropathy – LHON?
---livingcoexisting

09. If not, what is your relationship with Leber’s Hereditary Optic Neuropathy – LHON?
---FamilyFriendDoctor

10. If yes, which genetic variation?
---Without diagnosisG 11778 mutation14484 mutation3460 mutationOthersI don't have Lhon

11. Do you have LHON Plus symptoms?
---YesNoI don't know

12. If yes, which ones?

13. Are you on any treatment?
---YesNo

14. Which medicine do you use?
---idebenoneidebenone (Raxone)otherI do not take any medicine

15. In case you use another medicine, specify which one:

16. Do you have a medical follow-up with a neuro-ophthalmologist?
---YesNo

17. If you have a medical follow-up, indicate in which city:

18. Testimony