Get Involved Survey

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We’re excited you want to make a difference! Please fill out this survey to let us know more about you and how you’d like to get involved in Patients: The Heart of It All.

Personal Information

Name: Email Address: Phone Number:

Your Connection to HCM

Are you an HCM patient or caregiver? (Select one)

HCM Patient Caregiver Both

Have you been diagnosed with: (Select one)

Hypertrophic Cardiomyopathy (HCM) Hypertrophic Obstructive Cardiomyopathy (HOCM)

Your Interests and Availability

Would you like to get involved in the following areas? (Check all that apply)

Grassroots advocacy efforts
Speaking engagements
Media appearances
Patient advisory boards
Surveys and input
Volunteering at events
Peer support
Organizational leadership
Writing opportunities
Educational outreach
Fundraising efforts

Do you have any unique skills or experience that could contribute to our mission?

Your Goals and Preferences

How much time can you commit to volunteer activities per month?

1–2 hours 3–5 hours 6–10 hours More than 10 hours

What inspires you to get involved with this organization?

Do you have a specific area of interest or passion within HCM advocacy?

Additional Information

Would you like to receive updates from us?

Yes, via email Yes, via text message No, thank you

Do you have any questions, ideas, or suggestions for our organization?

Patients: The Heart of It All is a registered 501(c)(3) non-profit organization. Contributions are tax-deductible to the fullest extent allowed by law. EIN: 99-1020457