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Empowering Lung Cancer Patients
Empowering Lung Cancer Patients

Lung Cancer Buddy Support Request Form

We understand that navigating lung cancer can be challenging, and having a supportive buddy can make a significant difference. Please fill out the form below to request a buddy who can offer support, share experiences, and help guide you through this journey.

Personal Information

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How did you find out about the Buddy Program?

Date of Year

Medical Information

Buddy Support Preferences

Preferred Buddy Characteristics: (Select all that apply)
Type of Support Needed: (Select all that apply)

Availability

Preferred Communication Method: (Select all that apply)

Additional Information

Consent

I consent to the use of my personal information for the purpose of connecting with a buddy support person. (Privacy Policy Link)
I agree to receive communications regarding buddy support from this website.
I voluntarily agree to participate as a Buddy Supporter for emotional and peer support only. I will not provide any medical advice, treatment recommendation, or healthcare consultation. All medical concerns must be discussed with qualified healthcare professionals.
I confirm that no money, fee, gift, or financial benefit will be requested or accepted for this support service. I also understand that Lung Connect India Foundation is only facilitating the connection and shall not be responsible or liable for any issues arising from the Buddy Program interactions.

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