Sjögren’s India Event - July 2021
Sjögren’s India is planning a virtual event for patients and their families to learn about conquering Sjögren’s syndrome and Living like Champions! Your responses will help us design a programme that would be meaningful for you. The information you provide will not be shared with anybody.
If you need help filling the form, please leave a message on
sspatientgroup.india@gmail.com
or send a WhatsApp message on Sjogren’s India Helpline +91 8200749362 and we will get back to you.
Kirtida Oza
Co-Founder Director
Sjögren’s India
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Patient's Name
*
Your answer
If you are filling the form for a patient please give your name and how the patient is related to you.
Your answer
Patient's Gender
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Female
Male
Prefer not to say
Contact e-mail
Your answer
Phone number for Contact (Preferably WhatsApp)
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Please enter your phone number without any spaces. For numbers other than India please include the ISD code. If you have problems entering your number please include it in the 'other information' section at the end of this form.
Your answer
City
*
Your answer
Patient's Age
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Your answer
How may years ago did the patient get a confirmed diagnosis of Sjögren’s syndrome?
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less than 2 years
2-5 years
5-10 years
greater than 10 years
Sjogren's India has a Patients/Family Members Only WhatsApp Group. Please indicate your response.
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Sjögren’s India is planning a Virtual Event for Patients and Family in July 2021. Are you interested in attending.
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Maybe
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