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Newly Diagnosed/New to the C3 and CCF Initial Survey

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In partnership with the Cholangiocarcinoma Foundation (CCF), the C3 is proud to provide access to Cholangiocarcinoma Foundation Care Kits for Canadians

 

In order to collect a cholangiocarcinoma care kit, please provide your contact information as indicated below.

  • Only one (1) care kit per household

  • Care Kits are only available to CAD residents on this site and are only offered in English at this time. US residents can obtain care kits by clicking here

  • Only available to cholangiocarcinoma patients and their caregivers

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Please answer the following questions so we can better serve you. This information will also be shared with the Cholangiocarcinoma Foundation to further their mission to find a cure and improve the quality of life for cholangiocarcinoma patients.

Contact 

Veuillez fournir les coordonnées du patient

How did the patient hear about the Cholangiocarcinoma Foundation?
How did the patient hear about the Canadian Cholangiocarcinoma Collaborative (C3)?
Quand le patient a-t-il reçu le diagnostic de cholangiocarcinome ?
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What type of cholangiocarcinoma was the patient diagnosed with?
Which race/ethnicity best describes the patient? (Select all that apply)

[C3 staff can help assist with resources, clinical trial information, and providing emotional support, among other things]

Thanks for submitting!

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