Living With XXY Community Sign-Up

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Thank you for wanting to be a part of our wonderful community. This short form is to help us understand our communities' needs and those who wish to share their stories, so others know they are not alone. Please fill out the following form, and Ryan will contact you. Our nonprofit is small, and we are growing bigger each year. Contact times will vary, so we thank you for your patience. Everything we do is for the internationl community though we are based out of San Diego, CA. All information is confidential. By completing this form, you give Living With XXY Nonprofit access to your personal information. Thank you,

Ryan Bregante
President & Founder

Email *

Please choose one of the following. You are: *

Adult with XXY 18+

Currently Pregnant

Parents with XXY baby 0-7

Parents with XXY kids 8-13

Parents with XXY preteen 14-17

Parents with XXY Adult

Spouse or partner of someone with XXY

Family member or friend of someone with XXY

Sibling of someone with XXY

Other:

First/Last Name *

Phone Number

Address/City/State/Country (We send out small awareness packets via Postal. We also have a mapping system Ryan built to create a community in your local area. Please add your complete mailing address if you are interested in either of these.) *

Please provide your Facebook URL, Instagram handle, and anything else you use for social media.

Are you open to meeting and talking with other families and men with XXY? We will do our best to connect you with people from our community. *

Yes

Other:

How open are you about you/your sons diagnosis? *

VERY OPEN (i.e., open in all settings)

SOMEWHAT OPEN (i.e., open with most circles, but cautiously private in certain settings such as the workplace)

SOMEWHAT PRIVATE (i.e., family + medical professionals)

VERY PRIVATE (i.e., only parents or spouse knows)

Age of Diagnosis (Adult/Person/Son with XXY) *

Current Age of (Adult/Person/Son with XXY) *

Are you interested in participating in our blog series. We have an incredible writing team focused on creating life changing stories. We have over 92 stories from people around the world. This will require a 1 hour video interview. If yes, Ryan will be in contact with details. *

Yes

Are you interested in participating in our podcast. Currently we have 49 episodes. This is a easy phone call and conversation. If yes, Ryan will be in contact with details. *

Yes

Have you tried Micro-Tese fertility surgery?

Yes, It was sucessful

Yes, it was not sucessful

Clear selection

Only for adult men with XXY, do you have kids?

Sperm Donor via IUI

Sperm Donor via IVF

Adoption

Embryo Adoption

Micro-Tese

Naturally (very rare)

Step Dad

Other

What are the things your son with XXY or you as an adult with XXY struggle with? *

What are the positive attributes your son with XXY or you as an adult with XXY have? *

Is there anything you would like to add or hope to see in the future from Living With XXY?

Would you like to Volunteer for Living With XXY? If so, do you have any special skills you would like to offer or what you would like to help with. Thank you

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