Citizen Health Changemakers

Looking to be a Changemaker?

We're building a small first group of patients and caregivers who share their story and help other rare disease families find their way.

To get started, tell us a bit about you and we'll be in touch.

ABOUT YOU

Full name *Email *Where are you based? (city, state / country) *

I confirm I'm 18 or older. *

Your connection to rare disease

Which best describes you? *

Patient

Caregiver of a patient

What condition(s) are you connected to? *How long have you been on this journey? *

Under a year

1-3 years

3-7 years

7+ years

Are you part of a foundation or community? Which one, and your role? (optional)Roughly how many families/people do you reach in that community? (optional)If you'll be posting about a child, what is their age? (optional)

Your social presence

Which platforms are you active on? *

Instagram

Facebook

TikTok

Youtube

Blog/Newsletter

None yet

Your handles / links (one per platform) *Approx. followers on your main platform (your best estimate) (optional)Are your accounts public or private? *

Public

Private

Mixed

Willing to make public

How often do you post? *

Daily

A few times a week

Weekly

Monthly

Rarely

Who mostly follows you? (a sentence) (optional)Share a post you're proud of (link) (optional)

Your "why"

Why do you want to be a Changemaker? *

Partnerships & guidelines

Do you currently have brand partnerships, or promote any health / medical apps? (list any) (optional)Are you comfortable disclosing paid partnerships (FTC) and letting us do a light review of program content before posting? *

Yes

I have questions

Other

How did you hear about us? (optional)Anything else you'd like us to know? (optional)

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By submitting you agree that Citizen Health may contact you about the program using details you provided. Learn more in our privacy policy. Please do not use this form to submit Personal Health Information.

Guides for Newly Diagnosed Families

Terms Privacy Patient Consents Community Rules