Helpline peer match form

Tell us what you are looking for in a peer match and we will contact you within two business days to begin the process to match you to a Helpline Volunteer.

For financial help, please contact us by emailing grantinfo@lbbc.org rather than filling out this form.

Phone number(Required)

Other time zone (please specify)(Required)

What year were you born? Please enter full four-digit year (e.g. 1990).(Required)

When were you diagnosed with breast cancer?

Month of diagnosis(Required)

Year of diagnosis(Required)

To ensure the best possible match, if you know your stage number, please type it here:

Is there anything else that you would like us to know in order to match you in a meaningful way?

Additional information

Please consider answering the following optional questions:

Are there any aspects of your identity that are important for us to know to better match you with a Helpline Volunteer?

Helpline peer match form

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