CDH International - A Global Initiative to Stop Congenital Diaphragmatic Hernia

Your Name *

Your E-mail *

Your Phone Number

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Patient’s First Name *

Patient’s Middle Name or Initial

Patient’s Last Name *

Patient’s Year of Birth

Patient’s Year of Death (if applicable)

Are you a member of CDH Internatinal? (join for free at http://www.cdhboards.org) *

Please tell us 5 interesting things about the patient. (see the featured images for example)

How has CDH International helped you? (this might be quoted on our site, social media and/or a press release)

Are you presently holding a fundraiser or event that you would like us to promote? Please give us all information to share. (date, location, web site, etc)

Please write 1 paragraph (3 or 4 sentences) about your diagnosis and pregnancy. (this might be quoted on our site, social media and/or a press release)

Please write 1 paragraph (3 or 4 sentences) about surgery and NICU. (this might be quoted on our site, social media and/or a press release)

Please write 1 paragraph (3 or 4 sentences) about your present situation; coming home, current status, grief, etc. (this might be quoted on our site, social media and/or a press release)

Do you give us permission to use you / your child’s photo in publications, on social media and to share with the media? *

Do you give us permission to use you / your child’s photo in other publications? (web site, yearbook, calendars, guides, etc)?

File Uploads – 3 photos please (birth, now, family) (.jpg or .png file format only) *

File Uploads – Video of your story. See instructions below please.

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Current Fundraisers: Week of November 11th

RESEARCH: “Congenital diaphragmatic hernia in newborn infants: Variable endotracheal tube and umbilical venous catheter positions”

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