Autoimmune Disease Form - Autoimmune Sisters

Hi there,

We think it’s awesome that you have decided to help us complete one of our Autoimmune Disease pages. These pages are so important for the many women that visit our site to find good information about their disease while feeling comforted having you as a point of contact for more support.

In order for us to be a valuable resource to the women that visit our website, the following form provides the areas of most importance. Please complete all of the fields below before submitting it to me.

Once we receive this form from you, we will follow up with any questions or to let you know when the disease page is published on our site.

Thank you!

Autoimmune Sisters Disease Team

Your Name:*
Your Email Address:*
Enter Email Confirm Email
ABOUT DISEASE
Name of the Autoimmune Disease you're supporting:*
Tell us about the Autoimmune Disease:*
List the Autoimmune Disease symptoms:*
DISEASE POINT OF CONTACT
If you know someone that may be interested in being a point of contact for this disease, please leave their email address or instagram handle in the first field below. If you are interested in being this disease point of contact, please fill out the additional fields in this section.
Email address or Instagram handle of a referral point of contact for this disease.
Name displayed on our website:
Your instagram handle that will be displayed on our website:
Upload a headshot of yourself that will be displayed on our website:
Provide 2-3 sentences about you, your disease and why someone should reach out with more questions about this disease.
MORE DISEASE INFO
List type of specialist or provider.*
List blood/lab tests to determine diagnosis.*
List medications/supplements.*
Provide methods of healing.*
List some helpful websites, authors or other resources that someone with this disease would find useful.*
SOURCES: Please list any websites that you referenced in this disease form.
Permission:*
- I give permission for AUTOIMMUNE SISTERS to share this information on the @AutoimmuneSisters instagram feed and/or on their website www.AutoimmuneSisters.org.
Medical Disclaimer:*
- I understand that I am not a substitute for professional medical advice, diagnosis, or treatment. I will always advise anyone that contacts me via the AutoimmuneSisters.org website that is seeking medical advice, diagnosis or treatment to contact their physician or other qualified health provider with any questions they may have regarding a medical condition.

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