Bone Sarcoma Peer Supprt Mentee Form

Request a Mentor

To request a mentor please complete the details below... the more info you can provide the better the match.
What's your first name?*
Do you use a preferred name?
What's your surname?
Bone Sarcoma Peer Support will need to call you to discuss your request for a mentor. Please provide a phone number below.
Can you tell us your preferred contact number?*
How would you like Bone Sarcoma Peer Support to send other information

EmailPost
What is your email address?*

Confirmation Email
Can you tell us your address?*

Street Address

Street Address Line 2

CityCounty

Post Code

Further information

In order to match you with a mentor we need some further information from you. We'd really like to collect this now via this form. If you prefer though we can collect it when we call you. If you select yes, it'll take approx 10 minutes to complete. If you select no, please click next and then complete the final page.
Do you want to complete this now?*

Your information

All of the information is optional but the more you can provide the better the match we can make.
What is your first/preferred language?
We'll try to match you with someone that speaks your language
How important is it that we match you to someone who speaks this?
Are you fluent in other languages? If so, what are they?
We'll try to match you with someone that speaks your language
How important is it that we match you to someone who speaks this?
How would you describe your ethnicity?
We only use this info to create better matches
How important is it that we match you to someone who shares your ethnicity?
How would you describe your gender?
We only use this info to create better matches
Is there a gender you would prefer to be matched with?
How important is it that we match you to your preferred gender?
We hate to be rude, but how old are you?
Unfortunately we do not currently offer the service for those under 18. We would recommend speaking to Sarcoma UK or Macmillan
How important is it that we match you to someone who is of a similar age?
Can you please provide your postcode?
We will only use this to create better matches
How important is it that we match you to someone who lives near you
How often would you want to talk to a peer?
How would you prefer peers to contact you?*

EmailPhoneText/WhatsApp etcVideo ChatMeet in Person^
^Please note this may not be possible in all instances
What is your email address?

Confirmation Emailexample@example.com

Your Sarcoma

Help us to understand your Sarcoma so that we can match you to the right mentor.
Which type of Bone Sarcoma were you diagnosed with?
How important is it that we match you to someone with the same Sarcoma?
What year were you diagnosed?
How important is it that we match you with someone close to your diagnosis date?
Have you had chemotherapy?
Are you expecting to have chemotherapy?
How important is it that we match you with someone that's gone through chemotherapy?
What stage are you at with the chemotherapy?
Have you had surgery?
Are you planning to have surgery?
How many surgeries have you had?
What year did you have the surgery for removing the tumour?
What type of surgery did you have to remove the tumour?
What type of excision did you have?
What type of endoprosthetic replacement did you have?
What type of amputation/disarticulation did you have?
What types of allograft did you have?
What type of reconstruction did you have?
Can you describe the surgery that you had?
What was your last major surgery?
What type of excision did you have?
What type of endoprosthetic replacement did you have?
What type of amputation/disarticulation did you have?
What types of allograft did you have?
What type of reconstruction did you have?
Can you describe the surgery that you had?
Do you have anymore surgeries planned?
What's the surgery that's planned?
What type of excision will you have?
What type of endoprosthetic replacement will you have?
What type of amputation/disarticulation will you have?
What type of allograft will you have?
What type of reconstruction will you have?
Can you describe the surgery that you will have?
How important is it that we match you with someone that's had the same surgery?
How important is it that we match you with someone that's been through that type of surgery?
How important is it that we match you with someone that's had multiple surgeries?
Have you had or are planning to have any other forms of treatment?

Proton beam therapyTargeted drugs/ trialsImmunotherapyOther
How important is it that we match you with someone who has had this form of treatment
Is there anything else from your condition and/or treatment that you would want to discuss with a mentor?
Think about things like pain, recurrent infections or physical limitations etc
Is there any specific support that you are looking for from a mentor?
Think about what support needs you may have eg practical advice, emotional support etc

Confirm your request
Bone Sarcoma Peer Support would like your consent to use the information you have provided.

We will use your data for the following purposes:
- To communicate with you
- To match you with a mentor
- To connect you with a mentor
- To promote, administer and evaluate the mentoring service
- To improve our operation
- For record keeping

We need to share your data with prospective mentors for the purpose of matching and connecting you.

For full details of how BSPS uses your information, please refer to our Privacy Notice.

You are fully in control of the decision to give consent and, if you change your mind, you can withdraw consent at any time by emailing hello@peer-support.co.uk or telephoning 0330 133 4314.

Please tick the box below if you give consent to Bone Sarcoma Peer Support to use your data.
I consent
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Request a Mentor

Further information

Your information

Your Sarcoma

Confirm your request