i need a sister

“There is no family history of breast cancer in my family, so being matched with others diagnosed with the same type of breast cancer was invaluable to me. Breast Connect helped me get through a stressful time of making difficult treatment decisions.”

– Patricia Robledo  /  Knoxville, TN

Diagnosed October 2014

Need A Sister

Welcome to the Breast Connect Sisterhood Program. We realize this may be early in your journey, but please know we are here for you. Please complete the form to the best of your ability as your situation stands now. Once you have submitted the form, we will find a sister survivor who best matches your criteria and provide you with her contact information. And if you haven’t already, please join our Facebook group at HERE.

    Name*

    Email*

    Phone*

    Date of Birth*

    Marital Status

    MarriedDivorcedWidowedSingle

    Race

    CaucasianAfrican-AmericanHispanicOther

    Kids

    YesNo

    Kids Ages

    0-55-1010-1515+

    Date of Diagnosis

    Metastatic Disease

    YesNo

    Metastatic Disease (If Yes, Where?)

    Please check up to 5 boxes for descriptions in which you would like to be matched.

    DCIS or LCIS

    DCISLCIS

    Receptor Status:

    ER+ER-PR+PR-Her2+Her2-

    Surgery Type

    Single MastectomyBilateral MastectomyLumpectomy

    Treatment

    Estrogen Blocker (ex: Tamoxifen)Aromatase Inhibitor (ex: Arimidex)ChemoNeoadjuvant ChemoHerception and PerjetaRadiation

    Type of Reconstruction

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

    BRCA Positive

    BRCA Positive

    Communication (please let us know your preferred method of contact and add any additional comments regarding your diagnosis that would help us find an accurate match for you. Someone will contact you within 72 hours)

    TextCallEmail

    Additional Comments (if any)

    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.

     

    BreastConnect.org 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.


    Testimonials