Connect with Us Let us know a bit about yourself. We care about you as an individual, whether you are diagnosed with HHT, a family member of a person with HHT, a medical professional, caregiver, or simply someone interested in HHT.By introducing yourself below and joining with us as a valued member of our community, we can better provide you with timely and valuable resources bout HHT. Contact Information SalutationPlease select... Mr. Ms. Mrs. Dr. Prof. Rev. Prefer Not to Answer First Name Last Name Email Email TypePersonalWork Phone Phone TypeMobileHomeWork Providing your address also helps ensure we can send you important news and updates about HHT, such as information about conferences in your area, notifications about research, our newslettre, and more. Street City State Zip Code Mailing CountryPlease select... 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If so, complete your address below. Deliveries presently limited to the US and Canada. YesNo Relationship to HHT and Background Primary Relationship to HHT PatientBiotech/Pharma industryFamily MemberFriendCorporate PartnerHealthcare Professsional Non-MDHHT Center PhysiciansIndependent HHT PhysiciansPhysicians Non-HHTResearch Translational MedicineResearch Basic ScienceResearch ClinicalSelect relationship that is most appropriate for you, although we recognize others may also apply. How were you diagnosed?Clinically Diagnosed with HHTGenetic Diagnosis with HHTI had genetic testing but inconclusiveI have family members diagnosed with HHT and I have symptomsNot tested/not sure If genetically diagnosed, which gene mutation was identified?HHT SMAD 4 Juvenile PolyposisHHT Type 1 - ENGHHT Type 2 - ALK1Inconclusive Results Symptoms - how are you affected by HHT? (select all that apply) Anemia Blood Clot Brain Abscess Brain AVM GI Bleeding Heart Failure Iron Deficiency Kidney Bleeding Liver AVM Liver Disease Low Oxygen Lung AVM Lung Hemorrhage Migraines Nosebleeds Pulmonary Hypertension Seizures Skin Telangiectasia Stroke Uterine Hemorrhage Have you visited an HHT Center?YesNo Which center(s) have you visited? (select all that apply)AL - Univ of Alabama at Birmingham - UNOFFICIALAR - Univ of Arkansas Medical SciencesAZ - Barrow Neurological InstituteAZ - Mayo Clinic - UNOFFICIALCAN - Edmonton ABCAN - Montreal QCCAN - Toronto ONCAN - Vancouver BC - UNOFFICIALCAN - Winnipeg MBCA - Stanford Hospital and ClinicsCA - Univ of California Los AngelesCA - Univ of California San Diego - UNOFFICIALCA - Univ of California San FranciscoCO - Univ of Colorado HospitalCT - Yale Univ School of MedicineDC - Medstar Georgetown Univ Hospital - UNOFFICIALFL - UF HealthFL - University of Miami - UNOFFICIALGA - Augusta Univ - MCGIL - Univ of Chicago MedicineIN - Indiana University - UNOFFICIALMA - Mass Gen Hospital BostonMD - Johns Hopkins UnivMI - Univ of Michigan HTCMN - Mayo ClinicMO - Wash U St. LouisNC - UNC Chapel HillNY - Albany Univ ENT - UNOFFICIALNY - Lenox Hill Hospital - UNOFFICIALNY - NY Presbyterian / CUMCOH - Cincinnati Children's HospitalOH - Cleveland ClinicOR - Pacific Northwest HHT COEOther Not ListedPA - Univ of PennsylvaniaPA - UPMC and The Univ of PittsburghTX - Texas Children's Hospital - UNOFFICIALTX - Univ of Texas SouthwesternUT - Univ of UtahVA - Univ of Virginia - UNOFFICIALWA - Seattle Children's Hospital - UNOFFICIALWI - Froedtert and Medical College of Wisconsin Demographics (optional) To develop tools that empower our diverse rare disease community, we ask community members to please select the demographic responses that are most representative. Birthdate GenderFemaleMaleNonBinaryPrefer Not to Answer Communications Preferences Cure HHT Text messages - I would like to receive information and updates via text messaging. Recipients can always opt-out by replying "Stop".Yes - Sign me upNo - Not at this time By clicking the Submit button, I acknowledge the following:The information provided on this form will be stored by Cure HHT and used to provide constituents with updates that better align with their needs and interests. For more information about our privacy practices, please visit www.curehht.org/privacy. By agreeing to the terms of consent, you agree that we may process your information in accordance with the terms of our privacy policy. Contact Information FOLLOW CURE HHT
