OstoChat Registration
Monday, April 1, 2024 at 6:30 PM EST. OstoChat, COGI's premiere support group for ostomates of all kinds. OstoChat is designed to bring the black and brown people of the ostomy community together to share tips, advice and to just chat about their experiences living with an ostomy.
Full Name:
*
First Name
Last Name
Address: City & State
*
Email Address
*
example@example.com
What gender do you identify with?
*
Male
Female
Non-Binary
What is your Ethnicity?
*
African American
Hispanic
Native American or Other Pacific Islander
Multi-Ethnic
American Indian
Asian
Caucasian
What is your age range?
*
18-25
26-34
35-50
Other
Have you been diagnosed with Crohn's Disease or Ulcerative Colitis (IBD)?
*
Crohn's Disease
Ulcerative Colitis
Neither
Do you know what a Chronic Illness Is?
*
Yes
No
Do you know someone with Inflammatory Bowel Disease (IBD)?
*
Yes
No
Does anyone in your immediate family suffer from IBD or any other chronic disease? (heart disease, cancer, diabetes, kidney disease, etc.)
*
IBD (Crohn's or Ulcerative Colitis)
Heart Disease
Lupus
Cancer
Diabetes
Kidney Disease
Other
None
Multiple Chronic Diseases
Are you a current COCCI Member?
*
Yes
No
If no, would you like more information on becoming a member?
Yes
No
If you haven't already, would you like to subscribe to COCCI's monthly newsletters?
Yes
No
Join OstoChat
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