Volunteer As A Sister Survivor

Thank you for your interest in volunteering as a Sister Survivor through our Sisterhood Program! Please complete the following form to the best of your ability and we will contact you when a match is made. All fields with an asterisk (*) are required. And if you haven’t done so already, please join our private Facebook Group.

    Address

    SingleMarriedDivorcedWidowed

    YesNo

    0-55-1010-1515+

    DCISLCISInvasive Ductal Carcinoma (IDC)Invasive Lobular Carcinoma (ILC)Inflammatory Breast Cancer (IBC)

    01234

    123+

    ER+ (Estrogen positive)ER- (Estrogen negative)PR+ (Progesterone positive)PR- (Progesterone negative)Her2+Her2-

    Single MastectomyBilateral MastectomyLumpectomy

    YesNo

    YesNo

    TamoxifenArimidex (anastrozole)Aromasine (exemastane)Femara (letrozole)

    Flat (no reconstruction)Tissue expander/implantDirect to implantLatissimus dorsi flapTRAM flapDIEP flap

    YesNoN/A

    YesNoN/A

    YesNo

    LungLiverBrainBone

    TextCallEmail

    Sister Survivor Disclaimer:

    The Breast Connect Sisterhood matching service is provided for the benefit of new breast cancer patients, with no compensation to either party. All interactions resulting from the connection between you and your “sister match” are personal and at the discretion of the new patient and survivor sister. Breast Connect is held harmless from any and all interactions and decisions resulting from the match. You hereby release and agree to indemnify and hold harmless Breast Connect, Inc. and its members, officers, directors, employees, and agents from and against any and all claims, liabilities, and damages arising out of the sharing or storage of any information you provide to us and from the interactions with persons with whom you connect through Breast Connect, Inc.

     

    Breast Connect, Inc. has not been established to sell healthcare, drive opinions, or be a persuasive source. By submitting a request to participate in the Breast Connect Sisterhood program, you are authorizing Breast Connect, Inc. to store your information in a database and, as appropriate, share the information you provide (including, without limitation, your name, medical diagnosis and contact information) with new patients seeking to participate in the Breast Connect sisterhood program.


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