Oxygen Management Working Group — Express Interest
Please provide your contact details, role, experience, and expectations to join the working group.
Section 1: Contact Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
City and State/Country
Section 2: Your Role
I am a:
*
Please Select
Parent/caregiver of a child with chILD
chILD Patient (age 13–17)
Young adult (age 18 or over) living with a chILD diagnosis
Pediatric Pulmonologist
Adult Pulmonologist
Nurse, NP, or PA
Respiratory therapist
DME (durable medical equipment) specialist
Social Worker
Researcher
Other
If you are a patient aged 13–17, please list the name(s) of your parent(s) or guardian(s) and their email.
*
If you are a medical professional or researcher, please list your organization/place of work and your job title.
*
Section 3: Additional Information
Is there anything specific you hope this working group will address?
How did you hear about the chILD Foundation CER Project?
Please Select
chILD Foundation website
Email from the chILD Foundation
Social media
A physician or care team
Another family or patient
Other
Submit
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