Affiliate - Johns Hopkins SKCCC Get Matched Form

You are not alone.

Cancer is isolating and frightening. We get it...and we have a network of survivors and caregivers who get it too and are standing by to help. They care because they have been there.

For more than 40 years, our team has been connecting patients and caregivers with trained Peer Mentor volunteers who understand.

Please complete the match request form below to start the process and a member of our team will reach out. We look forward to connecting you with one of our peer volunteers.

Demographic Information

First Name *

Last Name *

Email *

Phone *

Location

Cancer Hope Network is committed to upholding our client's privacy and will never share your personal information. If you prefer not to share your mailing address, please enter '0' in field

Time Zone *

Johns Hopkins Treatment Site *

Best ways to be reached *

Best times to be reached *

Birthdate/Current Age

Preferred Language(s) *

Ethnicity *

Gender Identity *

Cancer Experience Details

Cancer Diagnosis *

What type of emotional support do you currently have? (spouse/family, friends, groups, counselor, etc.)

Is there anything else that would help us understand your concerns and who may be the best match for you?

Cancer Hope Network will work to connect you with a trained Support Volunteer who has gone through a similar experience. Additional details about your current situation will be helpful as we work to make that match.

Life Circumstances

Please select all that apply. This additional information is helpful to our team as we work to find you the best match.

Please enter your contact information below if you are a healthcare provider referring a patient/caregiver for support:

Name and Title

Email Address

Phone Number