Generation Patient East Africa Peer Group Interest Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Generation Patient peer groups are a space for young adult patients (ages 18-35) with chronic conditions/NCDs to share their experiences and connect with others who deal with similar issues.

**Please note: these groups are only for young adult patients with a chronic condition - we do not allow researchers, doctors, or caregivers to “listen in” to our groups!

Thank you for your interest in joining a Generation Patient Peer group!! Please fill out this brief form, so we can share group information with you.

Email *

Full Name (First & Last Name) *

Are you a young adult with a chronic condition (NCD)?

Yes, I am a young adult patient with a NCD/chronic condition

No, I do not have a NCD (I am a doctor, researcher, or caregiver for someone with a NCD)

Clear form

Never submit passwords through Google Forms.

This form was created inside of Generation Patient (formerly the Health Advocacy Summit).

Does this form look suspicious? Report

Forms