Chronic Illness Friendship Club Sign Up Form
Hi friends thank you for being here.

1. We are launching our first hangout and need to gather best time zone for anyone interested!

2. If you'd like to be informed for our mailing list, upcoming meet ups in your area, new resources, virtual hang outs, resource lists, etc, keep scrolling to sign up below. 

3. Before you fill it out; FYI I have 2 factor authentication for (privacy purposes) / to access any data on this form I take privacy very seriously so anything you enter will be for the use mentioned below and or expansions related to this group, no 3rd party access 🤍

4. Also, I am not a doctor, I am just a girl with chronic illnesses and disabilities who wants to connect with others like me and build safe, accessible community for us to exist / connect in. 

5. With dwindling down programs here in the US +  my own challenges as a chronic illness girlie / semi newly diagnosed person, I really wanted to build something safe for other people with similar diagnosis, that might want to connect. 

If you’re still interested feel free to fill out the form below! (Our first hangout will be on Zoom or Jitsi)
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Name *
Pronouns
Email *
City *
Country *
If you’d like to be added to a signal group or discord 

You can add your Phone number here 

PLEASE INCLUDE COUNTRY CODE
(for later, if interested in Signal group or discord invite once it launches)
Your bluesky account / URL! 🤍✨
What are the most optimal days and times if we did a meet up virtually? Find your time zone here) Please add 2 day times and 2 afternoon/evening times if possible!: https://www.timeanddate.com/time/zone/  *
Sensory Needs / Accomidations / Needs
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Resource Wishlist /  Needed / Requests:

 (Chronic Illness Starter Pack, Resources in a specific location provider wise or Symptom Templates for a specific diagnosis, Meet ups virtual or in person be specific if you can :) )
Other accommodation not described above:
Would you prefer online Zoom hangouts or in person or both?
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Here’s our bluesky account if youd like to connect & follow us!:
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If the Zoom hangout was Sunday April 20th @ 3pm Pacific Standard Time; would that be a good time for you?
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Did anyone refer you? / how did you hear about us?  *
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