Affiliate - Mount Sinai Tisch Cancer Center Get Matched Form

You are not alone.

A cancer diagnosis can feel overwhelming, but support is here. Through our partnership with Mount Sinai Tisch Cancer Center, you can connect with a trained Cancer Hope Network Peer Mentor, a survivor or caregiver who’s been through a similar experience and is ready to help.

They understand because they’ve been there, and they’re here to offer support, encouragement, and real connection.

Please complete the form below to get started. A member of our team will be in touch soon to match you with a Peer Mentor. We look forward to walking this path with you.

Demographic Information

Mount Sinai Treatment Site

First Name *

Last Name *

Email *

Phone *

Phone Type

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

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 mentor 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

By submitting this form, I understand that Cancer Hope Network may contact me directly via phone, email, or text to complete an intake and begin the peer support process.

If I am a healthcare provider submitting on behalf of a patient or caregiver, I confirm that the individual has provided consent to be contacted directly by Cancer Hope Network.

I accept the Terms and Conditions