Patient Perspective Form

The ANF amplifies the voices of those affected by neuromuscular disease—patients, families, and caregivers—through compelling digital and print publications that raise awareness and shed light on the real-life impact of these diseases.

If you or a loved one has been affected by a neuromuscular condition and would like to share your perspective*, please complete the Patient Perspective Form below. Our team may reach out for a follow-up interview if an opportunity becomes available.

If submitting the Patient Perspective Form, please complete and include a Grant and Release form:

*If you are sharing information about someone else’s medical condition that is not a minor, they must provide consent by completing a Grant and Release form. If they are unable to do so, you must provide proof that you are legally authorized to act on their behalf.

Preferred Contact Method

Relation to Patient

Grant and Release Form

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Please attach your completed Grant and Release Form.

Legal Representation Documentation

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If sharing a story related to another persons' medical condition, please attach documentation of your authority to speak as their representative (e.g., general or durable Power of Attorney). Please note: Medical-only Power of Attorney will not be accepted.

Would you prefer a virtual interview or digital questionnaire?

Additional Materials (Optional)

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Upload any images or supportive material.