Fight Bladder Cancer Research Sign Up form
We would like to invite you to complete this confidential form in order to receive opportunities to take part in research. This includes our own research and selected third-party research studies which we support.
Fight Bladder Cancer supports research that will lead to better survival and quality of life for bladder cancer patients and their families, with a focus on projects that have a direct impact on patient care.
We will not give out your details, but, we, Fight Bladder Cancer will contact you with information on how to take part in bladder cancer research studies when they become available. This may include opportunities to take part in surveys, interviews, focus groups or medical trials. We will keep you updated by email on the research studies we're working on or are involved with. If you have any questions then please email
research@fightbladdercancer.co.uk
Yes, I am happy for Fight Bladder Cancer to contact me regarding research opportunities
Contact information - all information provided will be held confidentially
First Name
Last Name
Email
Telephone number
House name / number & first line of your address
City
County
Postcode
Country
Health information - all information provided will be held confidentially
Please let us know if you are a:
Bladder cancer patient
Carer or family member of a bladder cancer patient
Healthcare Professional, working with bladder cancer patients
What was your original diagnosis, if known?
Approx year of diagnosis
Age range at diagnosis
Under 18
18-60
60-70
70+
If you are a bladder cancer patient or carer, please let us know which hospital is giving treatment, so we can ensure they are receiving our materials to share with other bladder cancer patients
If you are a healthcare professional working with bladder cancer patients, please let us know which hospital you are based at, so we can ensure you are receiving our materials to share with other bladder cancer patients
Topics for research opportunities - all information provided will be held confidentially
Please indicate which of the following you have been affected by / involved with:
Mitomycin (course)
BCG (Bacillus Calmette-Guerin)
Chemotherapy - intravenous, into the vein
Immunotherapy - intravenous, into the vein
Epirubicin
Radiotherapy
Radical Cystectomy (bladder removal)
Stoma
Neobladder
Other urinary diversion
Other, please specify below:
Other communication from Fight Bladder Cancer
If you would like to receive the charity's monthly newsletter and copies of our Fight magazine when published, please complete this form:
https://www.tfaforms.com/4815822
Thank you, we will be in touch with you soon
Your details will be stored in line with our Privacy Policy which is available to view
here
Contact Information