Global Commission Intake Form

Help Support the Work of the Global Commission

Thank you for your interest in supporting the work of the Global Commission to shorten the time to diagnosis for children with a rare disease. Please complete this form to provide background about your work and areas of interest, and a representative from the Global Commission will be in touch as appropriate. This survey should only take 4-5 minutes to complete. By sharing this information, you will not be subscribing to any future communications.

Question Title

* 1. Please provide your:

Full name

Title and organization

Country of residence

Affiliation with patient advocacy organization (if applicable)

E-mail address

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* 2. Can you describe your current efforts and/or interest to shorten the time to diagnosis for rare disease patients? (Response limit: 300-word maximum)

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* 3. Which areas of the Global Commission’s work are you most interested in learning about or interested in supporting? Please select all that apply.

Technology Pilot Programs

Patient Empowerment Education and Awareness Campaign

Global Policy Framework

Other (please specify)

Global Commission Intake Form

Help Support the Work of the Global Commission

Question Title

* 1. Please provide your:

Question Title

* 2. Can you describe your current efforts and/or interest to shorten the time to diagnosis for rare disease patients? (Response limit: 300-word maximum)

Question Title

* 3. Which areas of the Global Commission’s work are you most interested in learning about or interested in supporting? Please select all that apply.

Question Title

* 4. Please list any resources that you are aware of for patients and families, or clinicians and researchers working to obtain a diagnosis.