SED HydrocephalusCONNECT Phone Request

 

Hydrocephalus CONNECT

A hydrocephalus diagnosis can be overwhelming.
A new challenge in your hydrocephalus journey can be difficult to manage.
Every experience with hydrocephalus is unique, and we want to connect you with someone who has ‘been there’ in a situation that is similar to yours.

Through our HydrocephalusConnect program you will be matched with trained Peer Support Volunteers based upon diagnosis, age, gender, relationship to hydrocephalus (patient, caregiver, parent, etc.), complications and/or comorbidities and other factors.

HA Peer Support Volunteers are ready to:
-Listen with compassion
-Share their experience
-Provide basic information about hydrocephalus
-Connect you with valuable information about HA and other resources available to help you and/or your loved one live fully with hydrocephalus!

To get connected with an HA Peer please complete the Form below and your HA Peer will reach out to you very soon!

HA Peer Connect Form:

*


 


 


 


*
Question - Required - Current Primary Treatment






 
Question - Not Required - Primary Shunt Type




 
Question - Not Required - Comorbidities (select all that apply)











 
Question - Not Required - Complications (select all that apply)

 
Question - Not Required - What is the patient's date of birth?




  Please provide your name, phone and zip code (it will help us find you a peer in your area):

*

Name:

 

 

   

*

*

ZIP / Postal Code:

 

 

 

What's this?

   Please leave this field empty