Below is a sample of the emails you can expect to receive when signed up to HAE a.
Troyce Venturella, MPH, RN, CCM
Health Advocate
10560 Main Street Suite PS40
Fairfax City, VA 22030
Office: (866) 798-5598
Mobile: (321) 412-0028
troyce@haea.org
Data Name | Data Type | Options |
---|---|---|
Cellular: | Text Box | |
First name | Text Box | |
Last name | Text Box | |
Text Box | ||
Phone | Text Box | |
Home address | Text Box | |
City | Text Box | |
State | Text Box | |
Zipcode | Text Box | |
Date of birth | Text Box | |
dropdown | Select... | |
dropdown | Select... | |
dropdown | Select... | |
dropdown | Select... | |
dropdown | Select... | |
checklist | What medication(s) do you currently use? | |
checklist | Berinert | |
checklist | Cinryze | |
checklist | Firazyr | |
checklist | Haegarda | |
checklist | Kalbitor | |
checklist | Ruconest | |
checklist | Takhzyro | |
dropdown | Select... | |
dropdown | Select... | |
dropdown | Select... | |
button | ||
reset |