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      • General Risk Assessment Tool
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MENUMENU
  • About Clots
        • Know Your Risk for Blood Clots
          • General Risk Assessment Tool
          • Women's Risk Assessment Tool
        • Signs and Symptoms of Blood Clots
          • How is DVT diagnosed?
          • How is PE Diagnosed?
        • Prevent Blood Clots
        • Blood Clot Treatment
          • Managing Anticoagulants Before, During, and After Medical Procedures
        • Stop the Clot, Spread the Word®
        • COVID-19 and Blood Clotting
        • Women & Blood Clots
          • Women's Risk Assessment Tool
          • Birth Control & Family Planning
          • Pregnancy & Childbirth
          • Treatment of Menopause Symptoms
        • Hospitalization and Surgery
          • Stop the Clot, Spread the Word™ Hospitalization
          • Toolkit for Knee and Hip Replacement Patients
        • Cancer and Blood Clots
          • Blood Clots and Cancer: What You Need to Know
          • Blood Clots and Cancer: What You Need to Know (Spanish version)
        • Athletes and Blood Clots
        • Travel and Blood Clots
        • Thrombophilias
          • Understanding Thrombophilia
          • Genetics of Thrombophilia
          • Shared Decision-Making Guide for Thrombophilia Testing
        • Children, Teenagers & Blood Clots
        • Caregivers
        • Atrial Fibrillation (AFib) and Clot-Provoked Stroke
        • Clinical Trials
        • Glossary
  • Patient Resources
    • Your Stories
      • Share Your Story in Writing
      • Share Your Loved One’s Blood Clot Story
    • Resource Center 
    • Psychological Impact of Blood Clots
    • Taking a Breath: A Stop the Clot Podcast
    • Questions to Ask Your Doctor After Having a Blood Clot
    • PEP Talk: Patients Educating Patients
    • Peer Support
    • New Patient Resource Guide
    • FAQs
  • Health Professionals
    • NBCA VTE Centers of Excellence™
    • Healthcare Professional Email Sign Up
    • Online VTE Curriculum – CE
    • Medical Messages
    • Adherence
    • DVT/PE Awareness Study
  • News
    • Latest News
    • Press Room
    • Newsletter
  • Get Involved
    • Events
    • Event Calendar
    • Email Sign Up
    • Ways to Give
    • DIY Fundraising
      • Facebook Fundraising to Help Stop the Clot®
    • How To Help
      • Become a Community Thrombassador
      • NBCA Interest Questionnaire
        • 12 Steps to Planning a Blood Clot Awareness Event
        • Volunteer Event Proposal Form
    • NBCA Sports & Wellness Institute: Team Stop the Clot
      • Team Stop the Clot®
    • Volunteer Spotlight
    • NBCA Corporate Roundtable
  • Advocacy
    • B.L.A.C.K. Church Bus Tour (coming soon)
    • Take Action Now
    • NBCA Advocacy Institute
    • Advocacy Updates
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  • #stoptheclotstory Community

Share Your Stop the Clot® Story

We invite you to share your blood clot story and help others understand the impact of blood clots.

Patient Story Submission Form

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Address*
e.g., estrogen-based birth control, long travel, surgery, hospitalization, etc.
e.g., DVT, PE, factor v Leiden, etc.
Choose your age range when first diagnosed.*
Which race or ethnicity best describes you? Please check all that apply.*
Which gender best describes you?*
Did you undergo a thrombectomy to treat your blood clot?
If you have factor V Leiden, which type do you have?
Were you gaslit by medical professionals when you were trying to get a diagnosis?
Medical gaslighting: When a medical professional invalidates, dismisses or ignores your concerns.
MM slash DD slash YYYY
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Accepted file types: jpg, jpeg, png, gif, Max. file size: 64 MB.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 64 MB.
Accepted file types: jpg, jpeg, png, gif, Max. file size: 64 MB.
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I understand that by submitting this form I agree to allow the National Blood Clot Alliance (NBCA) to use the information, photo and or video that I am voluntarily submitting as outlined in the Release Form.
Would like to receive communications from the National Blood Clot Alliance?*

 

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First date of your blood clot diagnosis
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Phone: 703.935.8845
Toll Free: 877.4.NO CLOT

National Blood Clot Alliance
PO Box 825687
Philadelphia, PA 19182-5687

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NBCA provides the information and materials on this site for general information purposes only. You should not rely on the information provided as a substitute for actual professional medical advice, care, or treatment. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment, or services to you or any individual. If you believe you have a medical emergency, call 911 immediately.