LCOM Foundation Sickle Cell Form
This form is used by LCOM foundation  (little cell of mine foundation) to collect information from sickle cell patients and their families to enable us reach those in need and provide necessary assistance as required. If you want to know more about LCOM and what we stand for, please read about us on www.littlecellofmine.com
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Email *
Please enter your first and last name *
Sex *
Date of Birth *
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DD
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Phone number (including country code) *
Are you a cell warrior? *
Tell us your warrior story (if filling on behalf of someone else, please explain) *
How do you manage your sickle cell disease? *
What medications do you use? *
How did you hear about LCOM? *
Have you read about LCOM *
What would you like LCOM to do for you? *
Would you be interested in an online sickle cell disease support group? *
If your previous answer was yes, please tell us what you would like to get from this group. *
Would you be interested in telling your story in our next season of Beyond the genetics? *
How would you rather be communicated with? *
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