Thank you for sharing your stories to help us improve awareness and understanding of this diverse disorder.

These stories will be used to raise awareness with the public, doctors, pharmaceutical companies and beyond on social media, our website and other outlets. 

Thank you for sharing your experiences. #collaboratingforacure

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* 1. Your Contact Information

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* 2. What is the name of your child with SCN8A? (We will only use your child's first name)

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* 3. What is your child's date of birth? (We will not share this but want to be able to accurately identify their age)

Date

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* 4. Please add photos and/or videos of your child with SCN8A here - the inchstones/milestones, the hard times, the good times and everything in between!

PNG, JPG, JPEG, GIF file types only.
Choose File

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* 5. What is your child's mutation (p. and c.)? We will not share your child's mutation but may share distinctions between our kids (i.e. GOF/LOF) to help highlight the spectrum of SCN8A. 

You may also send a copy of the genetic report to info@scn8aalliance.org (a closed email that will not be shared outside the International SCN8A Alliance).

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* 6. What have been your SCN8A child's biggest challenges?

Please share as much detail as you would like but please note that we may edit these to fit the needs of our space.

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* 7. What do you celebrate about your child with SCN8A? What have been their greatest achievements?

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* 8. What does your child with SCN8A enjoy or love to do/experience?

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* 9. If you could improve just one aspect of your child's condition or if you have a top goal for your child, what would you choose?

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* 10. Have some medications worked well for your child or others not?

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* 11. I authorize the International SCN8A Alliance to use the submitted photos on their websites, Facebook, Twitter, Instagram, and other media platforms.

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* 12. Would you like us to tag you when we post on social media? If so, please share links to your Twitter, Facebook and/or Instagram accounts.

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* 13. I certify that I  am a legal guardian of the child/children pictured in these photographs and have the full legal capacity to execute this release.

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* 14. Would you be interested in sharing your story in a video? We would walk you through the whole process. If you say Yes or Maybe, we'll reach out to you to share more. Thank you!

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* 15. I understand that (please check both):

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* 16. Would you like to share any feedback about the International SCN8A Alliance with us? We would love to hear from you and welcome testimonials to help others learn about the services we provide.

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