MyMito App Signup – Mito Community "*" indicates required fields Name* First Last Email* PhoneAddress Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country EthnicityCaucasianAfrican AmericanLatino or HispanicAsianSoutheast AsianNative AmericanNative Hawaiian or Pacific IslanderTwo or MoreOther/UnknownPrefer not to statePrimary LanguageArabicEnglishSpanishBengaliBhojpuriChinese- MandarinChinese – Wu or ShanghaineseChinese – Yue or CantoneseFrenchGermanGujaratiHausaHindiIgboItalianJapaneseKoreanMarathiPersian IranianPortuguesePunjabiRussianTagalogTamilTeluguTurkishUkrainianUrduVietnameseOtherGenderman/boywoman/girltransgendernon-binaryagendergender non-conforminggender fluidgenderqueertwo spiritothernone of theseprefer not to statePronounhe/him/hisshe/her/hersthey/them/theirve/ver/visxe/xem/xyrze/zieWhat is your connection to mito?* Patient Parent Spouse Caregiver Son Daughter Sibling Grandparent Grandchild Aunt Uncle Cousin Niece Nephew Friend Teacher/Educator Medical Professional Physician Nurse Genetic Counselor Social Worker Researcher Industry Rep Other Diagnosis TypeGenetically ConfirmedClinical DiagnosisUndiagnosedWhat is your diagnosis?* Alpers’ Disease ACAD9 Deficiency Autosomal Dominante Optic Atrophy (ADOA) Barth SyndromeA rare, genetic disorder of lipid metabolism that primarily affects males. CACT Deficiency CPEO Complex I Deficiency Complex II Deficiency Complex III Deficiency Complex IV Deficiency Complex V Deficiency CoQ10 Deficiency CPT I Deficiency CPT II Deficiency Creatine Deficiency Syndrome CUD/Primary Carnitine Deficiency Friedreich’s AtaxiaFriedreichs Ataxia GAII/MADD Deficiency Kearns-Sayre Syndrome (KSS) Lactic Acidosis LCHAD Deficiency Leigh Syndrome Leukodystrophy LHON LHON Plus Luft Disease MCAD Deficiency MCKAT Deficiency MELAS MEPAN MERRF MIRAS MitochondrialRelated to the mitochondria. Cytophy Mitochondrial DNA Depletion Mitochondrial Encencephalopathy Mitochondrial Myopathy MNGIE M/SCHAD Deficiency MMDS NARP Pearson SyndromeA rare disease that targets the bone marrow and pancreas. Through dysfunction of cells in the bone marrow that produce white and red bloods cells along with platelets. POLG Mutationsgenetic variant, genetic change POLG 2 Primary Mitochondrial Myopathy Pyruvate Carboxylase Deficiency Pyruvate Dehydrogenase Deficiency PDCD SCAD Deficiency Thymidine Kinase 2 Deficiency (TK2) VLCAD Deficiency Undiagnosed Other What is your child's diagnosis?* Alpers’ Disease ACAD9 Deficiency Autosomal Dominante Optic Atrophy (ADOA) Barth Syndrome CACT Deficiency CPEO Complex I Deficiency Complex II Deficiency Complex III Deficiency Complex IV Deficiency Complex V Deficiency CoQ10 Deficiency CPT I Deficiency CPT II Deficiency Creatine Deficiency Syndrome CUD/Primary Carnitine Deficiency Friedreich’s AtaxiaImpaired coordination of voluntary muscle movements. Manifestations can include, among others, slurred speech, poor balance, unsteady walking, falling, and involuntary eye movements (nystagmus). Usual GAII/MADD Deficiency Kearns-Sayre Syndrome (KSS) Lactic Acidosis LCHAD Deficiency Leigh Syndrome Leukodystrophy LHON LHON Plus Luft Disease MCAD Deficiency MCKAT Deficiency MELAS MEPAN MERRF MIRAS Mitochondrial Cytophy Mitochondrial DNA Depletion Mitochondrial Encencephalopathy Mitochondrial Myopathy MNGIE M/SCHAD Deficiency Multiple Mitochondrial DysfunctionThis is when mitochondria do not work as well as they should due to another disease or condition. Many conditions can lead to secondary dysfunction. Syndrome NARP Pearson Syndrome POLG Mutations POLG 2 Primary Mitochondrial Myopathy Pyruvate Carboxylase Deficiency Pyruvate Dehydrogenase Deficiency Pyruvate Dhydrogenase Complex Deficiency (PDCD) SCAD Deficiency Thymidine Kinase 2 Deficiency (TK2) VLCAD Deficiency Undiagnosed Other What is your loved one's diagnosis?* Alpers’ Disease ACAD9 Deficiency Autosomal Dominante Optic Atrophy (ADOA) Barth Syndrome CACT Deficiency CPEO Complex I Deficiency Complex II Deficiency Complex III Deficiency Complex IV Deficiency Complex V Deficiency CoQ10 Deficiency CPT I Deficiency CPT II Deficiency Creatine Deficiency Syndrome CUD/Primary Carnitine Deficiency Friedreich’s Ataxia GAII/MADD Deficiency Kearns-Sayre Syndrome (KSS) Lactic Acidosis LCHAD Deficiency Leigh Syndrome Leukodystrophy LHON LHON Plus Luft Disease MCAD Deficiency MCKAT Deficiency MELAS MEPAN MERRF MIRAS Mitochondrial Cytophy Mitochondrial DNA Depletion Mitochondrial Encencephalopathy Mitochondrial Myopathy MNGIE M/SCHAD Deficiency Multiple Mitochondrial Dysfunction Syndrome NARP Pearson Syndrome POLG Mutations POLG 2 Primary Mitochondrial Myopathy Pyruvate Carboxylase Deficiency Pyruvate Dehydrogenase Deficiency Pyruvate Dhydrogenase Complex Deficiency (PDCD) SCAD Deficiency Thymidine Kinase 2 Deficiency (TK2) VLCAD Deficiency Undiagnosed Other To signup for one-on-one support for MyMito visit: MyMitoHelp.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.