Share Your Story
Patient's Name
*
First Name
Last Name
Patient's Birthday
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relationship to Patient
*
Patient
Parent / Caregiver
Your Email Address
*
example@example.com
Tell us about your child. (How is their personality and what are their favorite things?)
*
Tell us about yourself (Profession, hobbies, anything you would like to share).
*
How old were you when you were diagnosed?
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How old were they when they were diagnosed?
*
What were the greatest challenges you and your family faced in the beginning and what are the biggest challenges today?
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What were the greatest challenges your family faced in the beginning and what are the biggest challenges today?
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What symptoms do you experience most often?
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What symptoms does the patient experience most often?
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What are your hopes for the future?
Is there anything else you would like to share about their MKD story?
Is there anything else you want to share about your MKD story?
Upload photo that captures your MKD story (can be either happy or difficult times)
Upload photo that captures their MKD story (can be either happy or difficult times)
Consent to Publish
*
SUBMIT
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