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My Scleroderma Story

Telling your story can be difficult. Where to start? What to say?
This questionnaire can help. A few words can make a big impact to a wide audience. Don't want to answer a question? Leave it blank. Don't worry if you don't think you write well. Just write what you feel.

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Name:

 

 

   

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City/State/ZIP:

 

    

 

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Date of Birth:

 

If you respond and have not already registered, you will receive periodic updates and communications from Scleroderma Foundation.

 


   


 

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Question - Required - Do you have scleroderma?





   


 

 

 

 

 

 

 

 

 

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