Scleroderma United - Share Your Story
Scleroderma United is an international 501(c)(3) nonprofit organization fostering patient-to-patient connections and empowering people with scleroderma around the world. Scleroderma Stories, our publication highlighting the hardships and passions of scleroderma patients, has reached over 10,000 people in 78 countries. By sharing your story, you can inspire other scleroderma warriors and teach more people about this disease. If you have scleroderma, we encourage you to contribute your story! If you know a scleroderma warrior with a story to share, we also encourage you to nominate them for a feature.

After this Google Form is submitted, a member of the Scleroderma United team will reach out to schedule an interview. Interviews are typically conducted via phone or Zoom and last between 30 minutes to 1 hour. 
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Email *
First Name *
Last Name *
What is the best way to contact you? *
Please share your email address and/or phone number
Are you submitting for yourself, or are you nominating someone else? *
If Nominating: Nominee's First Name
If Nominating: Nominee's Last Name
Nominee's contact information
Age? *
If nominating, please respond with the nominee's age
Where are you (or the nominee) located? *
City, State/Province, Country
Do you (or the nominee) identify as any of the following?
*Optional
Please share a few sentences about yourself! We will be in touch soon and look forward to meeting you :)
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