Share Your Loved One’s Blood Clot Story

About 100,000 Americans die every year from blood clots, and their lives deserve to be remembered and celebrated. If you have a loved one who has experienced a fatal pulmonary embolism, we would be honored to share their story.

Questions? Contact jlawson@stoptheclot.org

Loved One's Story Submission Form

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This field is for validation purposes and should be left unchanged.
Where did your loved one live?*
(Spouse, child, parent, sibling, etc.)
e.g., estrogen-based birth control, long travel, surgery, hospitalization, etc.
e.g., DVT, PE, factor v Leiden, etc.
Choose your loved one's age range when first diagnosed.*
Which race or ethnicity best describes your loved one? Please check all that apply.*
Which gender best describes your loved one?*
Did your loved one have a blood clotting disorder?
MM slash DD slash YYYY
Consent*
Would like to receive communications from the National Blood Clot Alliance?*
 

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