Survey - SED HydrocephalusCONNECT Phone Request

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:

Field Is Required What is your connection to the Hydrocephalus Association?

Hydrocephalus Type

Field Is Required Patient Diagnosed Age

Primary Cause of Hydrocephalus

Primary Shunt Type

VA (Heart)
VP (Abdomen)
LP (Spine)
VPL (Lung)

Field Is 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):

Field Is Required First

Field Is Required Last

Field Is Required ZIP / Postal Code:

Field Is Required Email:

Phone Number:

Yes, I would like to receive postal mail from Hydrocephalus Association

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