Join our Indian PH Patient Community on WhatsApp.

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Join our Indian PH Patient Community on WhatsApp.

Namaste 🙏🏽
To join our community, please fill up this form.
It won't take you more than ONE minute!

[After you fill up the form, a patient leader will contact you. During that interaction, we will request a copy of your last 2D Echo Report and your doctor's last case note/ prescription to better understand the type of your PH and your current PH status. We will also request a recent picture of you for your introduction in the support group.]

*We do not store patient data nor sell it to third parties.*

*Data is deleted after verification and your inclusion in the group.*

I am -

An adult Indian (age: 18+) living with Pulmonary Hypertension

Caregiver to an Indian adult/ child living with Pulmonary Hypertension

Patient's Full Name (If Caregiver, include names of both) *

Patient's WhatsApp Mobile Number (If Caregiver, include both numbers) *

Patient's Gender

Female

Male

Prefer Not to Say

Patient's Diagnosis: Type of Pulmonary Hypertension? *

Idiopathic PH

Heritable PH (Genetic causes)

PH due to Congenital Heart Defects (ASD, VSD, PDA, etc.)

Pulmonary Veno-Occlusive Disease (PVOD)

PH due to Lung diseases (COPD, ILD, Sarcoidosis, Sleep Disordered Breathing, etc.)

PH due to Autoimmune Conditions (SSc, MCTD, SLE, etc.)

PH due to pulmonary artery obstructions such as CTEPH, etc.

PH due to Left Heart Disease (Systolic & Diastolic Dysfunction, Valvular Heart Disease, etc.)

Multifactorial PH (Metabolic, Systemic and Hematologic Disorders, etc.)

PH due to other causes

Year of Diagnosis *

Name/ Some details of PH related surgeries, if any

Patient's Location in India *

Patient's Date of Birth: Date/ Month/ Year *

Names of your PH Doctors (Pulmonologist/ Cardiologist/ Rheumatologist etc.) *

Patient's Profession *

Patient's Hobbies and Interests *

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