Autoinflammatory story 2: What you would tell your past self, or others about living with an autoinflammatory disease?

form made July 21, 2025

Basic info

Thanks for wanting to share your autoinflammatory story! This information is to help us to organize your stories in our system. It will not be made public, outside of what you say in your video, and agree to in your consent below.

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First Name

Last Name

Age

Zip code- (Private)This helps us to organize our stories by region.

State, Country

Email: For us to contact you only. It will not be shared publicly.

Please fill in the box with the autoinflammatory disease that you or your loved one has been diagnosed with by a healthcare provider. Examples: CAPS, FMF, HA20, TRAPS, MKD/HIDS, DIRA, SAVI, PRAAS/CANDLE, etc.. ("unclassified autoinflammatory disease", USAID, SURF or "autoinflammatory syndrome" is ok to list too.

Are you a patient, caregiver/family member, or healthcare professional sharing this story?

patient over 18 patient under 18 (have your parent do consent-both parts) parent/caregiver/guardian medical professional

Consent for the Autoinflammatory Alliance to use your story, video and images online, in print, video presentations or social media? Please see our policy at this link: https://docs.google.com/document/d/1QGJxQeyPhy1ab_OFPQstcmuzpbKGzjVG/edit?usp=sharing&ouid=113741598162186287160&rtpof=true&sd=true

Consent for minor under 18 years of age in a video. I, the parent consent for this video to be shared. Please enter your name, and your child's name. We will not share content without this signed for any minor. If you submitting for yourself, and 18 years of age or older, you can skip this question. Consent for the Autoinflammatory Alliance to use your story, video and/or images online on websites, in print, presentations, or social media.

Date of Consent- If you are consenting for a minor-you must do both consent boxes, or we cannot share the child's story.

Sharing your story

Video 1.5 min max: What would your current self tell your past self (or other patients) about what has helped you live and cope with an autoinflammatory disease?

Please share your video 1.5 min max: What would your current self tell your past self (or other patients) about what has helped you live and cope with an autoinflammatory disease?

Anything else that you would like to share?

Additional photo