FORCE Peer Navigation Program

Welcome to the FORCE Peer Navigation Program. This program is only available for people from the United States and Canada. Please fill out this confidential survey so that we can try to match you to someone as much like yourself as possible. Once you submit your information, a FORCE Peer Navigator Volunteer will follow up with you within one week by email. Our goal is to provide you with resources that will empower you to make informed medical decisions with your healthcare providers. Thank you for reaching out to FORCE.
Acknowledgement
By completing this form, I understand that FORCE, its officers, directors, employees, and those volunteers in this program do not provide medical advice and that nothing provided by FORCE or the volunteers in this program either through the program or through the other materials or website of FORCE, are to be considered as medical advice and any information I receive from this program or from other FORCE materials should not be considered as such. I acknowledge I am providing information about myself and my medical condition voluntarily and understand that such information is collected in FORCE’s secure database. This information is accessible by FORCE employees only. I understand that FORCE shares the basic information I provide only to my selected peer navigator so that they may provide the appropriate information to me. If you would like your information to be removed from our database, please contact privacy@facingourrisk.org. In the event of a life threatening situation we reserve the right to contact emergency services. This program is only available for people from the United States and Canada.  Please read our full disclaimer and privacy policy.  
Contact Information









What is your time zone?
What time of day is best to reach you? (morning, afternoon, evening or share specific times)
Does FORCE have your permission to leave a voice mail if we cannot reach you by email?
Have you communicated with a Peer Navigator before?
Demographics: If you are a caregiver, please complete this survey for the person you are supporting.  









Have YOU, yourself, ever been diagnosed with cancer? Or if you are a caregiver, answer for the person you are supporting.  

Have you had genetic counseling?
Do you have a family history of cancer?

Genetic test results:


Which topic(s) interest(s) you?





Additional questions to help us assess your needs (optional)


Do you want to request an American Sign Language Interpreter for your call? 
FORCE Information


If you click Submit, and it stays on this screen, scroll up to make sure that you answered all questions that say "This field is required." and that there are no other error messages in red.

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