Your name

Your email (guardian/parent)

Your Phone Number(guardian/parent)

Where do you live?

State of Origin

Primary Care Hospital

Diagnosis of Warrior
PDATOFASDAVSDVSDTGACOAHLHSTruncusPulmonary AtresiaOthers

Stage in the journey
Yet to have surgeryOperatedAwaiting the next SurgeryCardiac Rehabilitation

What would u want us to help u with
Support financial emotionalTalk to a Cardiac liason NurseWant to talk to a Cardiologist

How did you hear about us?
Social mediaReferralGoogleOthers

Would you be willing to share your story with others
YesNo

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