Help for Lymphoma & CLL Patients in and leaving Ukraine
Lymphoma Coalition will do our best to get you the help you need.

We will collect your email and phone number to have 2 ways to reach you.  We will only communicate this information to trusted persons, including your doctor in Ukraine where necessary.

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Email *
Telephone *
Which languages do you speak? Tick all that apply *
Required
Are you *
The patient's first name and family name *
The patient's age *
The patient's gender *
The patient has: *
Required
What help do you need? *
Required
What treatment does the patient currently get?
Where is the patient right now?
Preference place for treatment
Please list where the European countries or Canada where you already have family and friends established.
Anything else you want to let us know?
Submit
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