Patient Engagement Intake Form

Patient Engagement Intake Form

Be Part of the Future of Lymphatic Research: Join ARPA-H Focus Groups
The field of lymphatic research recently received a federal investment of more than $300 million to fund the Advanced Research Projects Agency for Health (ARPA-H) LIGHT and GLIDE Programs. These initiatives are directed by leading research universities and hospitals across the country and aim to map the lymphatic system and accelerate the prevention and treatment of disease.

Patient, caregiver and clinician perspectives are essential to guide the development of new diagnostics, technologies, and therapies. If you are interested in participating in a virtual focus group, please complete the form below.

With your permission, LE&RN will share your contact details with research teams as focus groups are established beginning in April, 2026.
Name*

First NameLast Name
Credentials
EmailPhoneEither
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Under 1818-3031-4546-6061+
FemaleMaleNon-binaryPrefer not to say
Patient living with a lymphatic diseaseCaregiver / family memberAdvocate / patient organization memberClinician treating lymphatic diseaseOther
LymphedemaLipedemaLymphatic malformationComplex lymphatic anomalyPrefer not to sayOther lymphatic disease
PrimarySecondaryNot sure
PhysicianNurse practitionerTherapist / physiotherapistOther
Healthcare-related: Specialty
LymphedemaLipedemaLymphatic malformationComplex lymphatic anomalyPrefer not to sayOther lymphatic disease
PrimarySecondaryNot sure
YesNo
If you have any questions, please contact LE&RN's Science and Medical Director, Ajit Muley, at amuley@lymphaticnetwork.org.
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