Through NCCC's Phone Pals and E-Pals (E-mail Pals) Program, cervical cancer survivors are matched with other cervical cancer survivors who are now living with or have experienced similar circumstances, such as disease type or treatment regimens. Once the match is made, the new Phone Pals or E-Pals are free to contact each other for support, encouragement and, above all, hope.

 

To become a Phone Pal or E-Pal, please complete our Request & Contact Form, or for more information on Phone Pal, E-Pal or any other NCCC program, please call us at (818) 909-3849.

 

Please provide the following contact information
Name: *
Address:
City: *
State / Province: *
Zip/Postal code:
Country:
Telephone:
E-mail: *
   
Select all of the following options that apply

 I am a Patient
 I am a Survivor
 I am a Healthcare Provider
 I am a family member
 I am a Friend
 Other   

Type and Stage at Diagnosis
Precancerous
CIN I CIN II   CIN III
Stage 0 (Carcinoma in situ) Stage 1A Stage1B
Stage 2A Stage 2B Stage 3
Stage 4A Stage 4B
Clear Cell Carcinoma Squamous cell carcinoma   
Adeno carcinoma    Invasive cervical carcinoma
Others
Others
Age: *
Date first diagnosed (mm/dd/yyyy):
Treatment(s) received:
Date of first "clean" Pap smear
(mm/dd/yyyy):
Current state of cervical health: *
Best time to reach you via telephone:
Specify time by time of day:
Time Zone:
Would you prefer to have e-mail or telephone contact: *
Other:
I am interested in sharing my story with the media:
None Apply:
Comments

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