Community Outreach Program: Inhibitors in Hemophilia A & B

Calling all patients & families with inhibitors! You’re invited to attend an educational presentation & discussion presented by Dr. Doris Quon, Medical Director of the Orthopaedic Hemophilia Treatment Center. The primary focus of this program will be for those diagnosed with inhibitors. However, it is open to patients with Hemophilia A or B without inhibitors.

Dinner & activities will be provided. Thank you to our event sponsors HemaBiologics & PromptCare (formerly ARJ Infusion Services).

Please register by May 10th.

Community Outreach Program May 15th 2024

Adults Attending:*
Click the PLUS sign next to the box to add more. Diagnosis examples: Hemophilia A, Hemophilia B, von Willibrands, Carrier, Other, N/A
First Name Last Name Date of Birth Diagnosis
Kids attending:
Click the PLUS sign next to the box to add more. Diagnosis examples: Hemophilia A, Hemophilia B, von Willibrands, Carrier, Other, N/A
First Name Last Name Date of Birth Diagnosis
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email
Are you employed by a specialty pharmacy or product manufacturer?*
- No, I am not employed by a specialty or product manufacturer. .
- Yes, I am employed by a specialty pharmacy or product manufacturer.
Photo Consent Opt Out -From time to time, the Midwest Hemophilia Association (MHA) will want to use pictures and/or videos from our events to promote bleeding disorder programs and MHA's activities. Please check the box below if you would NOT like to grant permission to be able to use your image or those who have registered for that purpose.
- Yes I DO consent to the use of pictures of videos.
- No I do NOT consent to the use of pictures of videos.
Have ever experienced an inhibitor?
- Yes, I/we have or have had an inhibitor.
- No, I/we have not had an inhibitor.

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Date
Date(s) - May 15 2024 at 6:00 PM - 8:00 PM

Location
Main Event

Category(ies)

Community Outreach Program

First Name	Last Name	Date of Birth	Diagnosis

First Name	Last Name	Date of Birth	Diagnosis