{"id":109,"date":"2025-05-13T16:48:06","date_gmt":"2025-05-13T16:48:06","guid":{"rendered":"https:\/\/anachronist.co\/?page_id=109"},"modified":"2026-01-05T19:30:45","modified_gmt":"2026-01-05T19:30:45","slug":"interest-form","status":"publish","type":"page","link":"https:\/\/anachronist.co\/?page_id=109","title":{"rendered":"Interest Form"},"content":{"rendered":"\n<p>Welcome to the Anachronist Collective. I&#8217;m sorry you find yourself with a chronic or mysterious illness but I&#8217;m so happy you&#8217;re here. And happy to know you&#8217;re thinking about joining the Collective. <\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Life didn&#8217;t end at diagonosis and I want to help you adapt, overcome, and find joy. <\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Please fill out these questions so I can get to know a little more about your story. Even though we are more than our symptoms, they are still a huge part of our lives and I want to honor that. <\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-28f84493 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\"><style id=\"wpforms-css-vars-65-block-99a8eed5-37d7-41e1-a6f8-a83996f1f631\">\n\t\t\t\t#wpforms-65.wpforms-block-99a8eed5-37d7-41e1-a6f8-a83996f1f631 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-99a8eed5-37d7-41e1-a6f8-a83996f1f631 wpforms-render-modern\" id=\"wpforms-65\"><form id=\"wpforms-form-65\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"65\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F109\" data-token=\"e9278c5d1525a027ad266ccddd97e899\" data-token-time=\"1775613664\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-65-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-65-field_1\">What brought you to the Anachronist Collective? <\/label><input type=\"text\" id=\"wpforms-65-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-65-field_1-error\" ><\/div><div id=\"wpforms-65-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-65-field_2\">What do you want to make sure you get from this coaching relationship? (2 or 3 things)<\/label><input type=\"text\" id=\"wpforms-65-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-65-field_2-error\" ><\/div><div id=\"wpforms-65-field_3-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"3\"><fieldset><legend class=\"wpforms-field-label\">What area do you feel you are struggling with MOST right now in regard to your health? <\/legend><ul id=\"wpforms-65-field_3\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_3_1\" name=\"wpforms[fields][3]\" value=\"Hope and Faith\" aria-errormessage=\"wpforms-65-field_3_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_3_1\">Hope and Faith<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_3_2\" name=\"wpforms[fields][3]\" value=\"Friends and Family\" aria-errormessage=\"wpforms-65-field_3_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_3_2\">Friends and Family<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_3_3\" name=\"wpforms[fields][3]\" value=\"Love and Relationships\" aria-errormessage=\"wpforms-65-field_3_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_3_3\">Love and Relationships<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_3_4\" name=\"wpforms[fields][3]\" value=\"Work and School\" aria-errormessage=\"wpforms-65-field_3_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_3_4\">Work and School<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_3_5\" name=\"wpforms[fields][3]\" value=\"Life goals\" aria-errormessage=\"wpforms-65-field_3_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_3_5\">Life goals<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_3_6\" name=\"wpforms[fields][3]\" value=\"Accomodations\" aria-errormessage=\"wpforms-65-field_3_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_3_6\">Accomodations<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-65-field_4-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">What area do you feel you are struggling with SECOND most right now in regard to your health?  (copy)<\/legend><ul id=\"wpforms-65-field_4\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_4_1\" name=\"wpforms[fields][4]\" value=\"Hope and Faith\" aria-errormessage=\"wpforms-65-field_4_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_4_1\">Hope and Faith<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_4_2\" name=\"wpforms[fields][4]\" value=\"Friends and Family\" aria-errormessage=\"wpforms-65-field_4_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_4_2\">Friends and Family<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_4_3\" name=\"wpforms[fields][4]\" value=\"Love and Relationships\" aria-errormessage=\"wpforms-65-field_4_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_4_3\">Love and Relationships<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_4_4\" name=\"wpforms[fields][4]\" value=\"Work and School\" aria-errormessage=\"wpforms-65-field_4_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_4_4\">Work and School<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_4_5\" name=\"wpforms[fields][4]\" value=\"Life goals\" aria-errormessage=\"wpforms-65-field_4_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_4_5\">Life goals<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_4_6\" name=\"wpforms[fields][4]\" value=\"Accomodations\" aria-errormessage=\"wpforms-65-field_4_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_4_6\">Accomodations<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-65-field_5-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-65-field_5\">What is your chronic illness story? <\/label><textarea id=\"wpforms-65-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-65-field_5-error\" aria-describedby=\"wpforms-65-field_5-description\" ><\/textarea><div id=\"wpforms-65-field_5-description\" class=\"wpforms-field-description\">Feel free to be as specific or vague as as you&#8217;d like. <\/div><\/div><div id=\"wpforms-65-field_6-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-65-field_6\">How is your life  after your chronic illness? What do you no longer have that you miss?<\/label><textarea id=\"wpforms-65-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-65-field_6-error\" ><\/textarea><\/div>\t\t<div id=\"wpforms-65-field_9-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"9\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-65-field_9\" >do are right<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-65-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-65-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Where are you on your chronic illness journey? <\/legend><ul id=\"wpforms-65-field_7\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_7_1\" name=\"wpforms[fields][7]\" value=\"Something is weird with my health but I don&#039;t know where to start.\" aria-errormessage=\"wpforms-65-field_7_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_7_1\">Something is weird with my health but I don&#8217;t know where to start.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_7_2\" name=\"wpforms[fields][7]\" value=\"I&#039;m seeing doctors but I still don&#039;t have a name, just a lot of symptoms.\" aria-errormessage=\"wpforms-65-field_7_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_7_2\">I&#8217;m seeing doctors but I still don&#8217;t have a name, just a lot of symptoms.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_7_3\" name=\"wpforms[fields][7]\" value=\"Third I just got a diagnosis. But what does it mean??\" aria-errormessage=\"wpforms-65-field_7_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_7_3\">Third I just got a diagnosis. But what does it mean??<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_7_4\" name=\"wpforms[fields][7]\" value=\"I got a diagnosis 6 months or longer ago and I am exploring community and researching my condition.\" aria-errormessage=\"wpforms-65-field_7_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_7_4\">I got a diagnosis 6 months or longer ago and I am exploring community and researching my condition.<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_7_5\" name=\"wpforms[fields][7]\" value=\"I know about my condition and some of the resources\/community for it.\" aria-errormessage=\"wpforms-65-field_7_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_7_5\">I know about my condition and some of the resources\/community for it.<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_7_6\" name=\"wpforms[fields][7]\" value=\"I know about my condition, I&#039;m tracking research about it, and am actively part of the community.\" aria-errormessage=\"wpforms-65-field_7_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_7_6\">I know about my condition, I&#8217;m tracking research about it, and am actively part of the community.<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_7_7\" name=\"wpforms[fields][7]\" value=\"I know about my condition and others outside of it; I&#039;m a chronic illness expert at those point.\" aria-errormessage=\"wpforms-65-field_7_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_7_7\">I know about my condition and others outside of it; I&#8217;m a chronic illness expert at those point.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-65-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">What number POMI (person of mysterious illness) are you right now? <\/legend><ul id=\"wpforms-65-field_8\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_8_1\" name=\"wpforms[fields][8]\" value=\"POMI 1 -Not Sick, but you know something isn&#039;t right\" aria-errormessage=\"wpforms-65-field_8_1-error\" aria-describedby=\"wpforms-65-field_8-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_8_1\">POMI 1 -Not Sick, but you know something isn&#8217;t right<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_8_2\" name=\"wpforms[fields][8]\" value=\"POMI 2 - 1 + a handful of pills in the morning and evening; you suspect you&#039;re Sick\" aria-errormessage=\"wpforms-65-field_8_2-error\" aria-describedby=\"wpforms-65-field_8-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_8_2\">POMI 2 &#8211; 1 + a handful of pills in the morning and evening; you suspect you&#8217;re Sick<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_8_3\" name=\"wpforms[fields][8]\" value=\"POMI 3 - 2 + new symptoms that seem to always be bringing friends to the party\" aria-errormessage=\"wpforms-65-field_8_3-error\" aria-describedby=\"wpforms-65-field_8-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_8_3\">POMI 3 &#8211; 2 + new symptoms that seem to always be bringing friends to the party<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_8_4\" name=\"wpforms[fields][8]\" value=\"POMI 4 - 3 + You have tried Western, Eastern, holistic, etc. medicine; being sick is your life\" aria-errormessage=\"wpforms-65-field_8_4-error\" aria-describedby=\"wpforms-65-field_8-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_8_4\">POMI 4 &#8211; 3 + You have tried Western, Eastern, holistic, etc. medicine; being sick is your life<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-65-field_8_5\" name=\"wpforms[fields][8]\" value=\"POMI 5 - 4 + house\/bedbound, only going out (with immense help) for appointments\" aria-errormessage=\"wpforms-65-field_8_5-error\" aria-describedby=\"wpforms-65-field_8-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-65-field_8_5\">POMI 5 &#8211; 4 + house\/bedbound, only going out (with immense help) for appointments<\/label><\/li><\/ul><div id=\"wpforms-65-field_8-description\" class=\"wpforms-field-description\">Thanks to Sarah Ramey for her amazing descriptions in The Lady&#8217;s Handbook for Her Mysterious Illness. <\/div><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-65-field_9-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-65-field_9-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-65-field_9-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"65\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/anachronist.co\/index.php?rest_route=\/wp\/v2\/pages\/109\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-65\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/anachronist.co\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Welcome to the Anachronist Collective. I&#8217;m sorry you find yourself with a chronic or mysterious illness but I&#8217;m so happy you&#8217;re here. And happy to know you&#8217;re thinking about joining the Collective. Life didn&#8217;t end at diagonosis and I want to help you adapt, overcome, and find joy. Please fill out these questions so I [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-109","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/anachronist.co\/index.php?rest_route=\/wp\/v2\/pages\/109","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/anachronist.co\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/anachronist.co\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/anachronist.co\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/anachronist.co\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=109"}],"version-history":[{"count":3,"href":"https:\/\/anachronist.co\/index.php?rest_route=\/wp\/v2\/pages\/109\/revisions"}],"predecessor-version":[{"id":225,"href":"https:\/\/anachronist.co\/index.php?rest_route=\/wp\/v2\/pages\/109\/revisions\/225"}],"wp:attachment":[{"href":"https:\/\/anachronist.co\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=109"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}