Lupus Caregiver Questionnaire - Lupus Society of Illinois

Name*
First Last
Email*
Phone
Date
MM slash DD slash YYYY
Who in your world has lupus?*
Mother, father, daughter, son, sister, brother, friend, aunt, uncle, etc.
When did you first learn about lupus?
How has your life changed since your friend/family member's lupus diagnosis?
Please share your story.
Would you like your email shared on your story?*
- Yes
- No
Photo
Accepted file types: jpg, gif, pnd, pdf, Max. file size: 256 MB.
Please upload a photo you would like to accompany your story.