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First Name
Last Name
Email
Condition Connection
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General Interest
I am affected
My Spouse/Partner is affected
Another family member is affected
I have a friend who is affected
I lost someone who is affected
I am a medical professional
Other/Prefer not to respond
I/They are affected by
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Marfan Syndrome
Marfan Syndrome (Neonatal)
Loeys–Dietz Syndrome (LDS)
Vascular Ehlers-Danlos Syndrome (VEDS)
Bicuspid Valve
CCA (Beals)
Ehlers-Danlos Syndrome (EDS)
Aortic Aneurysm
Ectopia Lentis
MASS Phenotype
Shprintzen-Goldberg Sydrome
Stickler Syndrome
Unknown
Unspecified Related Disorder
My/their diagnosis is
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Suspected
Confirmed
Phone Number
Specialty
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Cardiology - Adult
Cardiology - Pediatric
Emergency Medicine
Genetic Counselor
Genetic Research
Medical Industry (Pharma, Medical Device, or Imaging)
Nurse
Nurse Practicioner
Patient Advocate
Physician
Physician Assistant
Primary Care Physician
Public Health Employee
Radiology
Scientist/Researcher
Surgery - Vascular
Surgery- Cardiac
Other
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