Join the Take a Pain Check Community!
Hello Take a Pain Check friends:)  Thank you for your interest in joining our discord community! We would love to get to know you before we give you the link to make some chronic illness friends. Please fill this out and we will email the link to you shortly.


Name  (first, last) *
Email *
What are your pronouns?  *
What is your preferred name? 
Where are you from? Country, state/province *
Age *
What is your connection with the rheumatic disease community? (ie. patient, friend or parent of someone, health care professionals etc.) *
What rheumatic disease do you live with? *
How do you want to get involved? *
Required
If you said other, feel free to expand on other ways you would like to contribute to TAPC and/or join the community!
Please list your social media handles *
What is your discord user name?
How did you hear about Take a Pain Check *
If you said other, feel free to expand here
I would like to get a monthly update from Take a Pain Check via email about how I can get involved in the chronic illness/rheumatic disease community
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