* Name Required * Preferred Published Name (anonymous, first name, pen name, full name, etc.) * Email Required * State Phone Please check all that apply.
I am diagnosed with a chronic or rare disease. I have received, or have been prescribed infusions, for my disease (past and/or present). I am a support person to a person with chronic or rare disease. I would like to share my story with the IAF team! I am interested in learning more about advocacy efforts. I would like to submit a blog or patient perspective poem for publication.
If you are interested in donating your art to our fundraiser - please describe your art and your best time to meet with our team. We appreciate your help! If you are a person with chronic or rare disease that is interested in sharing your poetry, please submit your text below. You can also email us your story at info@patientaccess.org.
By checking this box, you consent to Infusion Access Foundation publishing your poem.
Confirmation checkbox is required. * Name Required * Preferred Published Name (anonymous, first name, pen name, full name, etc.) * Email Required * State Phone Please check all that apply.
I am diagnosed with a chronic or rare disease. I have received, or have been prescribed infusions, for my disease (past and/or present). I am a support person to a person with chronic or rare disease. I would like to share my story with the IAF team! I am interested in learning more about advocacy efforts. I would like to submit a blog or patient perspective poem for publication.
If you are interested in donating your art to our fundraiser - please describe your art and your best time to meet with our team. We appreciate your help! If you are a person with chronic or rare disease that is interested in sharing your poetry, please submit your text below. You can also email us your story at info@patientaccess.org.
By checking this box, you consent to Infusion Access Foundation publishing your poem.
Confirmation checkbox is required.
