Navigating Relationships & Intimacy with An Ostomy
Monday, May 6, 2024 at 7:00 PM EST. Join us as we provide a safe space for an open discussion about relationships & intimacy with an ostomy. Yolanda will share her journey to reclaiming her confidence with an ostomy, then we will have a group discussion for participants to ask questions and share with one another. You don't want to miss this one!
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
Should be Empty: