Peer Support Leader Registration Form
Your contact details
Your Breast Reconstruction Story
Your story helps us to match your experience with women seeking specific support.
Have you been diagnosed with breast cancer?
Have you completed your breast cancer treatment NOT including BR surgery?
If no, when do you expect to be complete?
What type of breast reconstruction procedures have you had?
Saline expander and implant
Gas expander and implant
Latissimus dorsi flap
Other fat grafting such as BRAVA
Fat grafting only
Nipple tattooing with nipple reconstruction
3D nipple tattooing
What health system did you use through your surgeries?
What hospital/s were your surgeries performed?
Who were your surgeons?
What month and year did you have your breast reconstruction surgery?
Overall, how pleased are you with your breast reconstruction and add any comments regarding challenges you faced.
Your Support Options
What type of support would you like to offer?
Peer Support - Phone
Peer Support - face to face lunch group
Online community facilitator - RYC closed Facebook group
Online community facilitator - BCNA "Choosing Breast Reconstruction Group"
Online community facilitator - Q&A Ask an Expert
Administration support volunteer
Become a Reclaim Your Curves Ambassador.
Maybe, tell me more
Tell us why you want to volunteer, what skills you bring to the role.
Do you have any further comments or questions about this role?
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