Patient Perspectives Sign-Up
Join Brains for the Cure every first Thursday of the month on Zoom at 7 PM ET \ 6 PM CT \ 5 PM MT \ 4 PM PT for perspectives from other patients and survivors. The link for our Zoom call will be sent to anyone signed up before each conversation. Each month will focus on a different topic led by caregivers, patients, survivors, doctors, nurses, and other facilitators.

Contact for any questions or concerns.
Sign in to Google to save your progress. Learn more
First and Last Name *
Email Address *
Phone Number *
What is your preferred method of communication? *
Where do you live? *
What was your diagnosis and what is your status? *
How did you hear of Brains for the Cure? *
What topic(s) are you hoping to learn about during these calls? (Check all that apply) *
If you selected other, please include topic suggestions below.
We will send out a Zoom link for each month's call. In addition to your email provided, we can send the link to a caregiver/family member/friend that assists with scheduling and reminders. If you would like the link to be sent to someone in addition to you please list their name and email address below.
Please include anything else you'd like the Brains for the Cure team to know!
Clear form
Never submit passwords through Google Forms.
This form was created inside of Head for the Cure. Report Abuse