Test Form

Your Name:

Your email address:

Your Date of Birth:

Your Occupation:

Age of diagnosis or first crisis:

How has sickle cell disease impacted your life:

How have you overcome the challenges due to Sickle cell disease:

What advice do you have for persons living with sickle cell disease or the general public concerning this condition:

Any other matters:

Please attach any pictures that relate to your story (up to 4 allowed).