ILD Collaborative Virtual Community Meetings Please fill out and submit this one-time registration to access the ILD Collaborative Virtual Community Meetings. We will review your submission and get back to you shortly. First Name * Last Name * Email * Are you a patient or caregiver? * Patient Caregiver When were you (or the person you care for) diagnosed with an interstitial lung disease (ILD)? * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 How did you learn about the ILD Collaborative? * - Select -Health care providerA fellow patient or caregiver living with interstitial lung diseaseWeb searchOther What are reasons for joining the ILD Collaborative Virtual Community Meetings? Please check all that apply * To connect with other patients and caregivers living with interstitial lung disease To increase my understanding of interstitial lung diseases To find ways to improve my quality of life and/or my caregiver's living with interstitial lung disease To enroll into a clinical trial to further research in interstitial lung disease To increase awareness and share resources with my health care providers and community Other Are you (or the person you care for) actively being followed for interstitial lung disease by a health care provider? * Yes No If Yes, please check all that apply Primary Care Provider (PCP) Local Pulmonologist ILD Specialist at an academic institution How far do you (or the person you care for) currently drive to see your ILD Specialist? * Less than 50 miles 50 to 100 miles Greater than 100 miles Other What would you like to share with us?