1. Please tell us about your child/yourself

Tell us if this is a new portrait, if you are updating a portrait that is already in the gallery.

Create a New Portrait
Update a Portrait (see note in the box above)

Enter the CHD patient's first and last name for the article title. The last name will not be published. A middle name may also be entered, and will be used if entered.

    CHD Patient's First Name and optional Middle Name

    Last or Family Name (will not be published)

Enter the CHD patient's date of birth and please check if you would like to be listed on a birthday calendar that will be added to the site in the future. 

	Month
Date of Birth:	Day
	Year

Please include the name and birthdate on the birthday calendar

Enter a brief description of the patient's congenital heart defect and the most recent treatment.  This will appear in the heading of the introduction.  You will be able to provide much more detail below—this should be a summary.

Examples: "HLHS, Fontan", "HLHS, Transplant", "TOF, Complete Repair", or "TGA, Arterial Switch".

    Heading Diagnosis/Treatment (brief version)

Now please enter some information about yourself as the author of the portrait.  Enter your name as you would like it to appear at the end of the article.  Don't include last names.  Under "location", you can also enter a city and state, just a state, a country, or nothing at all. Please be aware that these pages are read by visitors from all over the world and are indexed by search engines, so please only provide as much information as you are comfortable providing. If listing more than one name, please list yourself (the author) first.

If the portrait is yours (that is, you are an adult with CHD), just give your name.

Examples: Beth and Jim, Freddy's Parents, and brother Billy

    Your Name(s) and relationship to the CHD patient

Optional: enter your location.  Don't be too specific--include a city only if you are comfortable in doing so.

Examples: Central Texas; Western Australia; Madison, WI.

    Location (optional)

Enter your email address. This email address will be used to

• confirm that you are a member (to avoid delays, please use the same email address that you used to join C.H.I.N.).  If you cannot, please add a comment so we can find your membership.

• notify you that your submission was received

• to contact you if there is a problem with your submission

• to notify you when your portrait is posted on the site

• to match future updates with this portrait

• to forward messages from site visitors to you (be assured that we will never give out your email address)

• or if we need contact you about the portrait for another reason

We value your privacy.  The email address will not be published, will not be shared with anyone outside of C.H.I.N., or used for any other purpose.  Click here to see our full privacy policy (another window will open).

    Email Contact Address:

2. Write the Introduction/Story

There are three ways to submit the portrait:

1. Type the introduction into the box below.  Do not press [Enter] at the end of each line (the words will automatically wrap to the beginning of the next line).  Do, however, press [Enter] twice to leave a blank line between paragraphs.

2. You can also write the introduction in a word processor like Microsoft Word or WordPerfect, or the Windows Notepad, Wordpad or Windows Write program, and then paste it into this field for submission.  To do this, select the text to be copied in your word processing program, then choose Copy from the Edit menu in your program.  Finally, click in the field below, click the right mouse button, and select Paste from the popup menu.  Your story will appear below.  Be aware that any formatting (bold, italic, fonts) will be lost.

3. You can submit the text by email.  Just type "story by email" in the box below and email the story to <portraits@tchin.org> at your convenience.  To avoid delays, be sure to include the patient's name, your name, and the email address you submitted above.  You can also submit photos to this address.

Here are some hints that will speed the posting of your story: please do not type in all uppercase letters, and be sure to break your story into paragraphs, rather than submitting one long paragraph (press [Enter] twice between each paragraph).  Both of these steps decrease the amount of editing that is needed and will speed up the process of getting portraits online.  Don't worry too much about spelling—all portraits are edited and we'll fix what we can. However, please do make sure that people's names are correct, since we often can't verify those.

3. Would you like to include a picture with the story?

Each story can include one or more pictures.  There are three ways to submit photographs:

1. If a photo is already on the web, enter the link below.  If there is more than one picture on the page, be sure to specify which picture(s) that you would like us to use.

2. Email the image to <portraits@tchin.org>.  Be sure to include the patient's name, your name, and your email address.  There are no size restrictions.  If you have more than one resolution, please send the one with the most detail (usually the largest file).

3. Send a print for scanning--the submission address will appear on the confirmation form that will appear after you submit this page.  If you would like the photo returned, please include a stamp.

Note that you can add or change the photo whenever you submit an update. We will  crop, resize, and/or resample the photo to minimize the time your page takes to download, fix red-eye, and make the photo match the style of the pages.  Please note any specifics when submitting the picture, like "Freddy is the third child from the left".  You can also enter a caption, like "Freddy's third birthday party!"

    Optional Photo Link or URL to website:

    Optional Photo comments or instructions:

4. Tell us about the diagnosis

This information will appear at the end of the article and is used to group portraits together.  Don't include treatments—those are in the next section.  Please either spell out the diagnosis, or use a well-known abbreviation.  Examples are HLHS (or Hypoplastic Left Heart Syndrome), TGA (or Transposition of the Great Arteries), and TOF (or Tetralogy of Fallot).

If you are submitting an update, and the diagnosis hasn't changed, just enter "same".  If there is an additional diagnosis (for example "reflux"), just type "add reflux". To remove a diagnosis, type "remove" followed by the diagnosis to remove.

Type the complete diagnosis into the box below.

5. Tell us about your / your child's treatments

This information will also appear at the end of the article and is used to group introductions together.  Examples are "Norwood Procedure", "Fontan", "Arterial Switch", "Unifocalization", "Transplant", or "TOF Complete Repair".  Type "None" if this is not applicable.  You can also wish to specify the month and year each procedure was performed.

If you are submitting an update, and the treatment hasn't changed, please enter "same".  If there is an additional treatment (for example, "Fontan"), just type "add Fontan". To remove a treatment, type "remove" followed by the treatment to remove.

Type the names of the operations and procedures  into the box below.

6. Tell us which C.H.I.N. mailing lists you use

This information may be added to introductions in the future so readers will know where to find you.  It's fine to leave these all unchecked.
 

7. Grant permission for the portrait to be published

This is the easy part--read the statement and then check the box below.  If you don't check this, we won't be able to publish your portrait unless you send a separate email message to <portraits@tchin.org> granting permission.

8. Additional Comments

If you have any comments, suggestions, or concerns about this site that you'd like to share with us, please enter them below.  These will not be published with the story.

9. Submit the story

Last step: click on the "Submit" button below just once to send the story.  A confirmation page will be displayed when the story is accepted by our server (please be patient--this may take several seconds).  You will also receive an automatically-generated email message indicating that your story has been queued for editing.  Finally, we will also send a message when the story is published. 

 
Please report any problems with this form to <sysadmin@tchin.org>
This form was last revised on January 03, 2008.