Pulmonary Hypertension Association
Survival Guide Feedback
Which version of
Pulmonary Hypertension: A Patient’s Survival Guide
do you have?
5th Edition, 2014 Revision – Print Book
5th Edition, 2013 Revision – e-Book
5th Edition, 2013 Revision – Print Book
5th Edition, Summer 2012
Other
If Other, please specify
Please use the space below to give us your thoughts and comments.
Permissions
I do not want PHA to use quotes from my evaluation in promotional materials.
First Name
*
Last Name
*
Email
*
Phone
Street Address
City
State
Zip Code
Are you a
*
Patient
Caregiver
Parent of a child with PH
Medical professional
Other
Maximum Allowed:
250
characters.
Currently Used:
0
characters.
Month/year patient diagnosed
*
If Medical professional - Title and Affiliation
Do Not Fill This Out