Peer Connect Registration

Do you have questions about transplant? Would it be helpful to talk with someone who has been through transplant? Peer Connect matches you with a transplant recipient or caregiver to share their stories and help answer your questions about transplant. These trained volunteers are available by phone or email. We match program participants with volunteers who are similar in age, transplant role (patient or caregiver), and diagnosis (disease or disorder). To do so, we’d like to ask you a few questions.

Demographic Information

We'd like to collect some basic information such as first and last name, contact information, and communication preference.

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9. Communication preference:*
12. You are a:*
13. If caregiver, your relationship to the patient:
15. Your gender:
17. Patient's gender:

The following questions ask about the patient's diagnosis (disease or disorder). We'd also like to know about the patient's transplant stage, center, and type (if known).

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20. Patient is:*
22. Type of transplant:*

We ask the last few questions so we can design programs and resources that are tailored for your needs and preferences. They require an answer to move ahead, but you can select ‘Decline to answer’ if you prefer not to respond.

23. Your ethnicity:*

Select all that apply.

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25. Your highest level of education:*

Internal purposes only.

If you're a patient or caregiver, please leave the box empty and select 'Next' below. If a Be The Match BMT Patient Navigator completed this form for a participant, enter your name below and note if this was a BRC request:

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