Request a FibroConnect mentor

We’re glad you are interested in the FibroConnect Program

If you are interested in being matched, please complete the form below to help us match you with an appropriate peer mentor. Every effort will be made to match you to a mentor with a similar profile and familiarity with the issues and topics that you request below.

FibroConnect registration

“*” indicates a required field

"*" indicates required fields

Name*
Location
What is your (or the patient's) current disease staging?
What treatments have you been offered? (Check all that apply)
What was your (or the patient's) approximate date of diagnosis
I am
I'd like to be matched with a
Please identify any issues or topics you would like to discuss with your mentor (select all that apply):
Consent to be contacted by FCF and peer mentors*
Agreement to keep conversations confidential*
For more information, please email us at fibroconnect@fibrofoundation.org.
This field is for validation purposes and should be left unchanged.

Please note: Peer mentors are not health professionals and do not provide medical advice. By participating in the FibroConnect program, you acknowledge that you understand the program is for support purposes only and does not provide legal or medical advice. The FibroConnect program may provide helpful health-related information, but it is not intended to substitute for professional advice, diagnosis, or treatment.

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