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Health Educator Contact Form

All fields marked with an * are required. Your address information enables us to direct you to local resources which you may find to be helpful.


Todos los campos marcados con * son requisitos. Su direccion nos ayuda dirigirle a los recursos que le podrian ayudar.


This information is provided with the understanding that the LFA is not engaged in rendering medical advice or treatment recommendations. The material provided is designed for educational and information purposes only and as a benefit and service in furtherance of the LFA's mission. Information should not replace necessary consultations with a qualified health care professional to meet your individual needs.


Salutation/Saludo:
Street/Calle:
* City/Ciudad:
* State/Estado:
Zip Code/Código Postal:
Country/País:
Phone/Número de teléfono:
Gender/Sexo:
Year of Birth/Año de nacimiento:
Language/Idioma preferido:
How did you hear about LFA?/¿Cómo se enteró Ud. de la Fundación de Lupus de América?
If Other/Si otro:
Who are you seeking information for?/¿Para quién busca información?
Have you been diagnosed with Lupus?/¿Esta persona se ha diagnosticado con lupus?
If so, when were you diagnosed?/¿Cuando se diagnosticó?

 
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