PTENUKI BUDDY SCHEME
Address (including Post Code):
Date of Birth:
Prefer not to say
Name of Hospital(s) / regional centre:
Name of Genetic Consultant:
PTEN diagnosis (tick as many boxes that apply):
If you are answering for a Family member or Friend please put their name and age here
ABOUT YOU/YOUR FAMILY:
We want to try and match our buddies to their needs. For example, somebody new to diagnosis may wish to chat somebody who has lived for sometime with theirs. Perhaps you might wish to chat with somebody of a similar age, or have specialist experience that you feel might be of use to somebody. You may have a young child, and would like information from families with older children / young people who can add insight to your children.
Do you need support
Wish to provide support
Have specialist knowledge / experience
Anything else you wish to find / share
Particular support you are looking for at this time?
Have specialist knowledge/ experience e.g. thyroidectomy/prosthetic surgery/genetic counselling
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service