Peer-To-Peer

Peer-to-Peer Navigators are lung cancer survivors or supporters (family members and caregivers) who have walked the lung cancer path. They know how difficult it can be dealing with lung cancer. Peer-to-Peer Navigators are volunteers who can mentor; offer encouragement, advice, experience, and hope to those newly diagnosed or anyone needing additional support through a one-on-one personal connection.

Peer-to-Peer Navigators can be a vital link for a patient by being an empathetic supporter and navigator through the logistics and emotions of living with lung cancer.

If you have been affected by lung cancer and would like to be matched with a Peer-to-Peer Navigator, or if you are a patient, survivor or supporter who would like to serve as a Peer-to-Peer Navigator, please fill out the form below or contact us at info@lungcancercanada.ca

All information provided is kept confidential and is never shared with anyone except your support partner.

This program is a free service from Lung Cancer Canada.

Peer to Peer Support Request Form

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First Name:
Last Name:
Age:
Gender:	Male Female
Address:
Address 2:
City:
Province/State:
Postal Code:
Country:
Phone Number:
Email:
I am a:	Patient Caregiver Other
If other, please specify:
I am seeking:	to provide peer to peer support to others to receive peer to peer support from a mentor
Seeking support for:	General Support Clinical Trials Treatment Information Other Check all that apply
If other, please specify:
Availability:	Phone Email Both
Languages spoken:	English French Mandarin German Italian
Others:	Please list any other languages
Diagnosis Date:	Date and time
Age at Diagnosis:
Type of Lung Cancer:
Stage at Diagnosis:
Current Stage:
Gene Mutations:	EGFR ALK PDL 1 Expression Other
If other, please specify:
Previous Treatment:	Surgery Chemotherapy Radiation Targeted Therapy Immunotherapy None
Please List:	If checked, please list names of all previous chemo, targeted and immunotherapy drugs.
Current Treatment:	Surgery Chemotherapy Radiation Targeted Therapy Immunotherapy None
Please List:	If checked, please list names of all previous chemo, targeted and immunotherapy drugs.
Experience with:	Obtaining a second opinion Managing financial implications of cancer Being a parent to young children while on treatment Clinical trials Alternative therapies Working while being a caregiver/receiving treatment
Is there anything else you would like us to know:
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