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I Would Like to Connect to a
Patient Outreach Volunteer.
First Name
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Last Name
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Street address
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State/Region
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Postal code
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Email
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Mobile phone number
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What is your relationship to SAF?
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Please Select
I have scarring alopecia.
I am a spouse, relative, or friend of someone with scarring alopecia.
I am a dermatologist who treats scarring alopecia patients.
I am not a dermatologist, but another healthcare professional.
I am a medical student.
I am a trichologist.
I am a hairstylist and/or cosmetologist.
I represent a pharmaceutical or research company.
I work for a company that provides products for scarring alopecia patients.
Other
What is your type of scarring alopecia?
Please Select
CCCA (Central Centrifugal Cicatricial Alopecia)
FFA (Frontal Fibrosing Alopecia)
LPP (Lichen Planopilaris)
FFA + LPP Combination
FAPD (Fibrosing Alopecia in a Pattern Distribution)
AM (Alopecia Mucinosa)
CP (Classic Pseudopelade Brocq)
DLE (Discoid Lupus Erythematosus)
DC (Dissecting Cellulitis)
EPD (Erosive Pustular Dermatosis)
FD (Follicularis Decalvans)
FK (Folliculitis Keloidalis/Acne Keloidalis Nuchae)
GLS (Graham-Little Syndrome)
KFSD (Keratosis Follicularis Spinulosa Decalvans)
Other Type Not Listed Here
Don't Know
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