WhatsUp With You?
TIME TO TALK: Coping with Mom's Cancer
Live Chat on WhatsApp for Teenagers and Young Adults

WITH

Jihane Ghorayeb - Psychologist
PhD Researcher (University of Leeds, UK)

BROUGHT TO YOU BY

One Wig Stand: www.onewigstand.org
(t) 01-203112 (m) 79-158471

Last Revision: May 16, 2015
First Name: *
Last Name: *
Nickname:
Age: *
If you are below 18 years old, we will require the consent of a parent or legal guardian. Please insure that they contact OWS at their earliest convenience prior to the chat date.
Your Phone Number *
Write the number that you'll be using to connect to the chat even if it's not your personal number.
Your Email Address *
How long ago was your mom diagnosed? *
What is your mother's cancer stage? *
The stage of cancer indicates the size of the tumour of abnormal cells and whether or not those cells are contained to the place of origin.
What treatment stage is your mom currently at? *
What type of cancer is she undergoing/did she undergo treatment for? *
If your mother was diagnosed with more than one cancer, please state her initial diagnosis in the "Other" box.
How would you describe your family structure? *
If non of the below seem to fit the description of your family, please specify your family structure in the 'Other' box
In the family order, are you: *
If you are NOT 'an only child' specify the gender and position of siblings in the 'Other' box ( example: I am the middle child, 2 older brothers and 1 younger sister)
Who do usually you go to to talk about how you feel and what's happening to your mom? *
If you select 'Other', please specify your answer in the box below
How do you wish to be identified in the chat? *
OWS will attempt to maintain your privacy at all costs, however, you must be advised that the settings of chat room do not permit to mask your phone number.
What language do you prefer the chat to be in? *
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