She Blossoms Connection Form
Fill in your name, contact details, whether you have been diagnosed with Lupus or any other autoimmune disease, what kind of support you would like to receive. A She Blossoms Connection Advocate will contact you for a brief interview shortly after this.
Mobile Phone Number
To Contact You
Please enter valid email address
Lupus ( SLE, Discoid, Drug Induced, Nephritis)
Other Autoimmune Disease
I think I have Lupus but I have not been diagnosed
Fibromyalgia or Other Pain Disorder
Other Non Communicable Chronic Illness
Would you like to explain the diagnosis section?
A brief history if appropriate will help us know how to assist you better. We will keep this information confidential.
How would you like us to assist you?
Locate a Doctor
Connect me to a Support Buddy
I need a Patient Advocate
I need counseling
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