Caring Connection Program - Request Support

Caring Connections Program: Talk to a Survivor or Caregiver

If you or a loved one is going to have a transplant or CAR T-cell therapy, chances are you're feeling anxious and overwhelmed.

BMT InfoNet's Caring Connections Program can help!

Simply complete the form below to connect with a transplant or CAR T-cell survivor or caregiver, or a bone marrow or stem cell donor.

Talk with someone who:
•    has been through a transplant, CAR T-cell therapy
•    has experienced similar side effects
•    understands how you feel
•    can provide non-medical information and emotional support
•    can offer tips for coping with household and job responsibilities, the needs of other family members, and more

If you have questions phone BMT InfoNet at 888-597-7674.

Please! Do not request a Caring Connection for anyone other than yourself, unless the person has explicitly asked you to do so.

First Name

Last Name

Phone Number

Phone Type

Cell

Landline

Street Address

Street Address Line 2

City

State/Province

Postal Code

Country

Your Birth Month and Year

Patient Info & Relationship

Relationship to Patient

Relationship Other

Patient First Name

Patient Last Name

Diagnosis Info

Disease

Type in diagnosis to see list or select Other and complete the disease description.

Disease Description -

If your disease was not listed above enter it here.

Disease Subtype

What type of therapy did you/the patient have or will have?

Transplant - bone marrow, stem cell or cord blood

CAR T-Cell Therapy

Unsure

Other…

Transplant Info

Number of Transplants

Date of Most Recent or Possible Transplant

Patient Age at time of transplant

Your Age at time of the transplant

Transplant Type

Donor type

Type of cells used

Transplant Center Name

Have you had your transplant?

Yes

Notes about Previous Transplants (PRT)