MG Patient Support

Let us help connect you to support. We offer a variety of ways that you can get support through our programming.

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* 1. Contact Information

Name

Phone Number

Mailing Address

City

State

Zip

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* 2. Please tell us your time zone.

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* 3. What time of day is best to connect with you? Check all that apply.

Morning

Afternoon

Evening

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* 4. What day of the week is best to connect with you? Check all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

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* 5. I am interested in getting support by (check all that apply):

Connecting with an MG Friend

Joining a Patient Support Group

Joining a Caregiver Support Group

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* 6. I am a:

Patient

Caregiver

Parent of Child with MG

Family Member

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* 7. MG Patient Year of Diagnosis

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* 8. Patient Year of Birth

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* 9. Do you have any physical needs that require special arrangements?

Yes

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* 10. MG Type

AchR antibody

Musk+

Seronegative

Ocular

Generalized

Congenital

Other/Unknown

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* 11. MG Status (Check all that apply)

Stable MG

Unstable MG

On Disability

Working with MG

Have worked with MG

Retired

Pregnant with MG

In College with MG

Thymoma

Parenting with MG

Caregiving with MG

In remission

Have been in remission before

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* 12. What is the best way to communicate with you? Check all that apply.

Phone

Text

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* 13. What is your primary language?

English

Spanish

French

Other (please specify)

MG Patient Support

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* 1. Contact Information

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* 2. Please tell us your time zone.

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* 3. What time of day is best to connect with you? Check all that apply.

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* 4. What day of the week is best to connect with you? Check all that apply.

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* 5. I am interested in getting support by (check all that apply):

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* 6. I am a:

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* 7. MG Patient Year of Diagnosis

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* 8. Patient Year of Birth

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* 9. Do you have any physical needs that require special arrangements?

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* 10. MG Type

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* 11. MG Status (Check all that apply)

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* 12. What is the best way to communicate with you? Check all that apply.

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* 13. What is your primary language?

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* 14. Anything else you'd like to share?