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Patient Story Input Form
Growing awareness of VCP disease starts with telling our story. We appreciate your willingness to share the impact of VCP disease in your own life.

Your story will be considered for use in our marketing materials, including e-mails and our website blog. This will be a collaborative process with the Cure VCP Disease leadership team and you will have final review of final content.

By hitting "Submit" below, you are consenting Cure VCP Disease, Inc. to consider sharing your story on our marketing materials.

If you have any questions, please contact Leah Miles at leah@curevcp.org or info@curevcp.org
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First and Last Name *
What is your preferred e-mail address?
 *
Place of Residence (City, State, Country)
 *
How old were you when you first started experiencing symptoms? What was that like?
What was life like before your experiencing symptoms?
What symptoms were you experiencing that caused you to seek a diagnosis?
How were you diagnosed? What was your experience in getting your diagnosis?
Has VCP disease affected other family members?
What is life like for you now?  You can describe how your symptoms have progressed and what is difficult for you physically or mentally.  Please also include anything that brings you joy today.
What do you want the world to know about you and about living with VCP disease?  For instance: is there action for your readers to take, like advocate for rare disease patients, support Cure VCP Disease, be considerate of people with different abilities, etc.?
What else would you like to share with us about your story? Anything else that you would like to include?
Picture File Upload
Pictures are a great way to reinforce and amplify your story. Please share important pictures related to your VCP journey using the following link: https://www.dropbox.com/request/OJninME3SSv8VG2RSkms
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