I'm Interested in Support
Let's Build the Support You Need! Breast cancer affects people differently, and the support we need can change throughout the journey. Healthy Connections is building opportunities for connection and support for people affected by breast cancer in Northwest Ohio. We want the groups we develop to reflect what our community actually needs. If you are interested in participating in a future group, tell us a little about yourself and the kind of support you're looking for.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Type a question
*
Email
Phone Call
Text Message
Which best describes you?
*
I have recently been diagnosed with breast cancer
I am currently receiving treatment for breast cancer
I have completed treatment
I am a breast cancer survivor/thriver
I am living with metastatic breast cancer
I am supporting someone with breast cancer
I have lost someone to breast cancer
Other
I prefer not to say
Check all that apply
What kind of support are you looking for?
*
Connection with others who understand
A place to talk openly about my experience
Emotional support
Information about community resources
Support navigating life during treatment
Support adjusting to life after treatment
Family/caregiver support
Friendship/social connection
Wellness and self-care activities
Guest speakers and educational topics
Other
Check all that apply
What would make a support group feel valuable to you?
I would be most interested in:
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In-person meetings
Virtual meetings
Either
Not sure
How often would you realistically attend?
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Weekly
Twice a month
Monthly
Occasionally
Not sure
For family, friends & caregivers...What is your relationship to the person you're supporting?
Spouse/Partner
Parent
Adult child
Sibling
Friend
Other family member
Other
Would you be interested in a group specifically for the family, friends, and caregivers of people affected by breast cancer?
Yes
Maybe
No
Would you like Healthy Connections to contact you when new breast cancer support opportunities become available?
*
Yes
No
Would you like to receive information about Healthy Connections events and breast cancer awareness programs?
*
Yes
No
ADD ME TO THE INTEREST LIST
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