Community v2

1
Could you share your first and last name with us?We'd love to get to know you better.
First Name
Last Name
2
What's your email address?* This field is required.This will help us keep in touch with you.
example@example.com
3
What part of our platform are you interested in joining?Choose as many as you like.
RTHM Community
Newsletter
4
Are you navigating through any of the following conditions?Choose as many as apply.
Long COVID
ME/CFS
COVID vaccine related illness
Mast Cell Activation
Dysautonmia (i.e. POTS or orthostatic hypotension)
IBS
SIBO
Hashimotos thyroiditis
Hypothyroidism
EDS
I am a caregiver
Other
5
If you haven't taken the step to be a patient at the RTHM clinic, could you share why?* This field is required.
The cost is a barrier for me
I already have a clinician I trust
I'm already getting access to the latest diagnostics and treatments
RTHM doesn't cover my current state
Other
6
Please select the state you are located in:
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
7
Could you tell us which treatments or diagnostics you’re interested in the most?* This field is required.We want to provide information that's most relevant to you.
Huge
Large
Normal
Small
Ok
Ok
8
How familiar are you with the latest science?* This field is required.
I'm on top of all the latest research.
I keep up when I can.
I really don’t care, I just want to get better.
Other
9
What makes you most excited to join the platform? * This field is required. Choose as many as you like.
Cutting-edge research
Getting my questions answered by experts
Connecting with fellow long-haulers
Webinar expert interviews
Other
10
Where are you in your health journey?
[0-3 months] Just starting out on this journey
[3-6 months] A few months in, getting the hang of things
[6-12 months] Been in this for a while now
[1-2 years] Navigated around for some time
[2+ years] I'm well experienced in this journey
11
Do you know someone who might be interested in joining the RTHM Community?We'd love to extend our support to them too (optional)
Feel free to leave their email address here so we can reach out to them!
12
How did you hear about us?* This field is required.
A provider or RTHM patient referred me
A friend, family member, or colleague referred me
Facebook post
Twitter post
Google search
Instagram post
News article
Reddit
Other
Should be Empty: