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A-LiNK Patient/Caregiver Community
Please fill out the interest form below to get connected with our A-LiNK Patient and Caregiver Community!
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Full Name
*
Your answer
Are you a patient, parent, or other caregiver?
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Patient
Parent
Other:
Email
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Your answer
Phone Number
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Your answer
Age of Patient
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Your answer
If willing to share, what is your (patient's) diagnosis? Choose as many as applicable.
Primary Sclerosing Cholangitis (PSC)
Autoimmune Hepatitis (AIH)
Overlap/Autoimmune Sclerosing Cholangitis (ASC)
Inflammatory Bowel Disease (IBD) (Crohn's or Ulcerative Colitis)
Other:
At which hospital do you (or your patient) receive care?
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Your answer
What are you hoping to get out of this patient community? Eg. Medical support, advocacy opportunities, etc.
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Your answer
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