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ChronicUnity Matching Form
1.
Name
2.
Email
3.
Age
4.
Gender
Male
Female
Non-binary
Other
Prefer not to say
Other (please specify)
5.
What chronic illness do you have?
6.
How long have you had above chronic illness?
7.
Please list your interests/hobbies
8.
Why do you want to meet others with chronic illnesses?
Make a friend
Learn management tips and tricks
Help others
Emotional support
Newly diagnosed
I am a friend/family member of someone with a chronic illness