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We welcome your submission of general-interest medical questions. We cannot answer personal medical questions due to liability considerations. Your doctor knows you and your situation best, so please consult him/her with any questions you may have specific to your own individual case.

Your privacy is important to us; the Vasculitis Foundation will not sell or distribute your information to third parties.

Contact the Vasculitis Foundation

How can we help you?*
Name of Patient*
First Last
Your Name (if you are not the patient)
First Last
Spouse's/Partner's name (of the patient if applicable)
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Are you a?
- Patient
- Family/friend/caregiver of the patient
- Medical Professional/Institution
- Foundation/Corporate Partner
How did you learn about the Vasculitis Foundation? Please choose from the drop down menu.
Mobile Phone Number ( ) XXX-XXXX (for USA #s)
Email*
Enter Email Confirm Email
- Yes, I would like to receive email communications from the Vasculitis Foundation
Patient's Gender
- Male
- Female
What form of vasculitis does the patient have?
If "Other" please indicate what form of vasculitis
Approximate Date of diagnosis of vasculitis (MMDDYY)
Patient's Birthdate (MM-DD-YYYY)
- Private: Please check if you do not want your contact information released to other members or to chapter leaders for notification of meetings, awareness and fundraising activities.
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