Support Group Interest Form
Thank you for your interest in the trauma-informed support group for the desmoid community. All information will remain confidential and completing the form does not guarantee participation in the group. Please complete the form and we will be in touch with more details.
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile Number
*
Please enter a valid cell number that can receive text messages.
What is your age?
*
What is your gender identity?
*
Please select your relationship to the desmoid tumor community:
*
Patient
Parent
Partner
Family Member
Friend
Caregiver
Other
Are you currently seeing a therapist?
*
Yes
No
I am interested in attending the following support groups: (select all that apply)
*
Desmoid tumor patients (general)
Young adults with desmoid tumors (Ages 18 - 30)
Clinical trail desmoid tumor patients
Parents of children with desmoid tumors
Caregivers of desmoid tumor patients
Moms with a desmoid tumor diagnosis
Other (suggest a topic)
What is the best time for you attend a group?
*
Before 5pm my time
After 5pm my time
In which time zone do you reside?
*
Eastern
Central
Mountain
Pacific
Other
Are you ready to participate in a virtual group setting, to be vulnerable, and to be respectful of others' needs for a safe space?
*
Yes
No
Are you committed to attend all 8 sessions?
*
Yes
No
Are you willing to complete pre/post surveys to assist in program evaluation and data collection?
*
Yes
No
What do you hope to gain from this support group?
*
How did you hear about the support group?
*
Would you like to join our newsletter to receive updates about our programs and services?
*
Yes
No
Submit
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