Advocate – FAIR Time for Women Coalition

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Now is the time!

Are you interested in advocating for women's bleeding disorder issues? Would you like to share your story with the community and your legislators to see change take place?

We encourage you to fill out the form below and join the many advocates from FAIR Time for Women as we bring women's bleeding disorder issues to light!

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Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

What is your relation to the bleeding disorder community (check all that apply)

Person with a bleeding disorder
Spouse
Caregiver, guardian, sibling
Work at a pharmaceutical or biotech
Work at a specialty pharmacy
Work in clinical care, including at a hemophilia treatment center (HTC)
Other

If Other, please specify

If you (or your loved one) have been diagnosed with a bleeding disorder, what is the diagnosis? (select all that apply)

Hemophilia A
Hemophilia B
Von Willebrand Disease
Platelet Storage Pool Disorder
Unknown
No Bleeding Disorder
Other

If Other bleeding disorder, please specify

What medications do you have barriers to accessing and receiving?

What have you been told to do instead of using the desired medication?

How would you like to share your story with legislators? (select all that apply)

In-person with state and/or federal legislators
Online (via Zoom) with state and/or federal legislators
Tell your story in writing (handout to legislators or shared on our website)
Tell your story through video (shared on our website and socials)
Interview with a news organization
Testify at a legislative session
Other

If Other, please specify how you'd like to share.

What issues are you interested in advocating on? (select all that apply)

Access to care/diagnosis
Women bleeding disorders in general
Insurance/financial concerns
Access to medication
Other

If other advocating interests, please specify.

have your one)

Do you have any advocacy experience? (please share)

How else would you like to participate in FAIR Time for Women? (select all that apply)

Join the Coalition (free membership)
Sign on to support MASAC #264 (women’s bleeding disorder guidelines)
Subscribe to FAIR Time for Women’s newsletter

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FAIR Time for Women is building a grassroots movement to advance equitable access to diagnosis, care and treatment for women and girls and those assigned female at birth, with bleeding disorders such as hemophilia, VWD and others.

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