Stories for Cholangiocarcinoma Advocacy

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This google form was made to create a database of personal experiences from Canadian patients, survivors, and caregivers who have been affected by any form of cholangiocarcinoma.

We hope to collect as many stories as possible so that when it comes time to advocating for cholangiocarcinoma in Canada, we will be ready to respond quickly and contribute our voices.

Email *

Full name *

Province/Territory of Residence *

I am a... *

Patient/Survivor

Caregiver

Other:

Would you be willing to share your story with the media?

*Note: we will always let you know before publishing /releasing anything you submit through this form

Yes

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