Tell Us About You

Tell Us Your Story

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Do you currently suffer from Raynaud's?*
Your Age (in years)
Please enter a number from 16 to 110.
Please tell us your story*
Story Sharing Preference
- Yes, I am willing to share my story in a Member Spotlight article. (You would be notified, interviewed, and receive a draft for your approval prior to publication.)
Video Interview Preference
- Yes, I am willing to do a video interview to share my story.
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We’d Like To Hear From You

Please tell us about you! We’d like to know about your personal experience with Raynaud’s, such as:

How you were diagnosed?
Tell us about the hardships or limitations you experience as a Raynaud’s sufferer.
How you cope day-to-day (e.g. products and medications used).
Life changes you made.
Anything else you’d like to share with fellow sufferers.

We will not use your story without your express permission. You will be contacted if we select your experience to share in our publications, on our website, or with the press.