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ZERO's Black Men's Prostate Cancer Initiative Support Groups Interest Form
As a part of our efforts to continue improving and providing support through the Black Men's Prostate Cancer Initiative, ZERO has created support groups for Black men with prostate cancer. If you are interested in being a part of these meetings, please feel free to complete the form below to be added to the email correspondence list.
All of your information will be kept private and confidential and will not be shared with anyone outside of the organization. If you have any questions or concerns please contact the Health Equity Team (healthequity@zerocancer.org).
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Please enter your
first and last name
.
*
Your answer
Please enter your
email address
.
*
Your answer
Would you prefer to be a part of a virtual support group or an in-person support group?
*
I would prefer to be a part of a virtual support group.
I would prefer to be a part of an in-person support group.
To better connect you with resources, programs, and events related to prostate cancer in your area, please enter your city, state, and zip code.
*
Your answer
How did you learn about the Black Men's Prostate Cancer Initiative Support Group?
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Colleague, friend, and/or family member
Healthcare facility (doctor's office, urology clinic, cancer center, hospital, health clinic, etc.)
Cancer-focused non-profit organization
Other non-profit organization
ZERO Prostate Cancer
Were you previously aware of ZERO Prostate Cancer?
*
Yes
No
What are some of the issues you are facing in your prostate cancer journey that you would like more support for?
Your answer
Please let us know if you have any questions, comments, or concerns!
Your answer
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