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Submit A Story

 

We know having a Congenital Heart Defect has changed your life and we want to hear your story.


There is no age limit and we want to hear from you whether the person with the Congenital Heart Defect is alive or deceased. It’s just as important to hear from grandma, grandpa, aunt, uncle, cousin, sibling, friend or whomever would be willing to write. Please highlight experiences that have been challenging and how this has affected your life. Many do not understand the seriousness, lifelong affect and financial devastation a Congenital Heart Defect creates on everyone involved.

It is also important to include any other medical issues, learning disabilities and delays and emotional/mental toll it takes on those involved.

Submission Information:

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* Required information.
Name: *
Address: *
City: *
State/Province: *
Zip Code: *
Country *
Phone: *
Email: *
Preferred Language:

 

Please complete the following information about the patient affected by CHD.  If this is you, please complete for yourself. 

 
Patient's Name: *
Date of Birth: *
Date of Death (If Applicable):
Primary Diagnosis: *
Other: Please complete if your diagnosis is not listed or you have an associated diagnosis like down syndrome, etc...
Secondary Diagnosis:

 

Please tell us a little about your story and attach a picture...

 
Please share your story.... *
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Picture 1 * If your story is about your family, please share.
Picture 2 * If your story is about your family, please share.
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