WHAT IS YOUR KERATOCONUS STORY?
Spread keratoconus awareness and help other patients by sharing your keratoconus experiences on our blog. Please fill this form to submit your story and send one or more photos for the blog post to our email: story@keratoconusgroup.org
Sign in to Google to save your progress. Learn more
Name: *
First and last name. this will be added to your story. nicknames are not accepted.
Email address: *
We will use this to contact you.
Your keratoconus story: (Must be at least 2000 characters) *
You can write anything about Keratoconus, about your diagnosis, any treatments you had or your are going to have, and how you are living with this disease. Make sure to include a title for your story.
Please send one or more photos for the blog post to our email: story@keratoconusgroup.org
Social media profile: *
Username or address/URL of your Facebook, Instagram, or Twitter profile. At least one online profile is required.
How did you hear about us?
This is optional.
Tell us a little about yourself:
A short bio for your blog post. This is optional.
By submitting your story and photos, you agree that they may be published and shared on the Keratoconus Group blog and in our online communities and social profiles. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy