Patient and Caregiver Emotional Support (PACES)

The Be The Match® Patient Support Center offers free emotional support services. A licensed social worker can provide one-on-one support to help patients, caregivers, and family members of transplant cope with the blood and marrow transplant (BMT) and treatment process.

If you are interested in learning more about our PACES program, please complete this form. A social worker will reach out to you within 3 business days.

1. Contact/ general information:

Today's date:*

First name:*

Last name:*

Which best describes you:*

Select

If you selected 'other' for which best describes you, please specify:

Diagnosis*

Phone number:*

E-mail address:*

Transplant status:

Select

Transplant date:

How can we help you?*

2. Demographic Questions

We ask the last few questions so we can design programs and resources that are tailored to your needs and preferences. If you do not wish to answer these question please select 'prefer not to answer.'

Your ethnicity:*

Hispanic or Latino

Not Hispanic or Latino

Prefer not to answer

Your race: Please select all that apply.*

Select or enter value

If you selected 'not listed' for your race, please specify:

Your highest level of education:*

High School

Associate

Undergraduate/ Bachelor's

Graduate or Doctoral

Not listed

Prefer not to answer

If you selected 'not listed' for your highest level of education, please specify:

Send me a copy of my responses

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