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Share Your Poetry (Patients)

Name (if you would prefer to stay anonymous, you may write your initials)
Email
Introduce yourself!
If you are willing, please share a bit of information about your current condition
Which hospital do you currently attend?
Untitled multiple choice field
A
B
C
Would you like to be considered for the Poems for Patients Quarterly Literary Magazine?
Untitled multiple choice field
A
B
Please upload your poetry below (accepted file types: PDF, Docx, Doc, PNG, JPEG, JPG):